SELF-COMPASSION WRITING 1

Running Head: SELF-COMPASSION WRITING

Writing Can Heal: Effects of Self-Compassion Writing among Hong Kong Chinese College

Students

Celia C. Y. Wong

Winnie W. S. Mak

Department of Psychology

The Chinese University of Hong Kong

Author Note

All authors are affiliated with the Department of Psychology at the Chinese University of

Hong Kong, Hong Kong, China. Correspondence concerning this article should be addressed

to Celia Wong, Email: [email protected].

This article may not exactly replicate the final version published in the APA journal. It is not

the copy of record.

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Abstract

Self-compassion has been repeatedly shown to be associated with mental and physical well-

being. Recent studies showed that self-compassion writing can promote mental well-being,

but this has not been examined among Chinese populations. The present study examined the

effectiveness of self-compassion writing among Chinese students. One hundred and twelve

university students were recruited and randomly assigned into one of the following two

writing conditions: self-compassion writing and control writing. Participants were asked to

write according to the instruction for three times in a week and report their levels of positive

and negative affect immediately after writing. Self-reported depressive symptoms and

physical symptoms, as well as self-compassion (i.e., self-kindness, common humanity, and

mindfulness) and emotion regulation capacities (i.e., attention, clarity and repair) were

assessed at baseline and two follow-ups (1-month, 3-month). Results showed the self-

compassion writing group reported more negative affect across the three days of writing than

the control group. No significant group differences were found in depressive symptoms, self-

compassion components or emotion regulation capacities, but the self-compassion writing

group reported a significant drop in physical symptoms at the 1-month and 3-month follow-

up, while the control writing group reported no significant change in physical symptoms

across time. The findings suggested that self-compassion writing may benefit physical

health, but further studies should be conducted to examine its underlying mechanism.

Keywords: self-compassion, expressive writing, emotion regulation, Chinese

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Writing Can Heal: Effects of Self-Compassion Writing among Hong Kong Chinese College

Students

Self-compassion is a construct from Buddhist philosophy (Neff, 2003a), in which

compassion is defined as being aware of and having a concern to alleviate both suffering of

the self and others (Goetz, Keltner, & Simon-Thomas, 2010). It is a self-caring attitude in the

face of hardship or perceived inadequacy (Bennett-Goleman, 2001). Consistent with the

concept of “discriminating wisdom” in the Buddhist philosophy that asserts all actions are

experienced with a compassionate understanding (Goldstein & Kornfield, 1987), self-

compassion circumvents the entire self-evaluation process in the face of hardship or

perceived inadequacy and disregards the positive or negative aspects of the self (Neff, Hsieh,

& Dejitterat, 2005). Drawing on the writing of various Buddhist teachers (e.g., Salzberg,

1997), Neff (2003a, 2008) defined self-compassion with three components: self-kindness,

common humanity, and mindfulness. Self-kindness refers to being warm and understanding

towards the self when one is suffering or encountering inadequacy or failure. Instead of

passing harsh criticism and judgment on oneself, individuals with self-kindness treat

themselves gently, accept reality with concern and kindness, and experience emotional

equanimity. Common humanity refers to recognizing one’suffering and personal failure as a

shared human experience instead of an isolated experience that happens to one alone. The

last component, mindfulness, refers to maintaining a nonjudgmental and receptive mind state,

putting their aversive situation into a larger perspective, and observing own thoughts and

feelings with openness and clarity at times of adversities and hardships. The mindfulness

component in self-compassion differs from the general concept of mindfulness by focusing

on individuals’ state of mind during difficult and aversive situations rather than being a

mindset towards life in general (Neff & Dahm, in press).

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Self-compassion is similar to but broader than other positive aspects of the self that were

previously studied in literature related to self-esteem and humanistic psychology (Barnard &

Curry, 2011). Even though both self-esteem and self-compassion represent positive attitudes

toward the self, they are not equivalent but only moderately associated (Neff, 2003a). One

major difference is that self-esteem is contingent on social comparison (Tesser, 1999) and

meeting standards (Kernis, 2003) that tends to separate the self from others, while self-

compassion is not contingent on social comparison and it emphasizes the sense of relatedness

instead of separation (Neff & Vonk, 2009). Moreover, research showed self-compassion

could provide and explain additional variance of healthy functioning over and beyond those

explained by self-esteem (Neff & Vonk, 2009), suggesting the two self-concepts are distinct

from each other. Humanistic themes such as “unconditional positive regard” (Rogers, 1961)

and “unconditional self-acceptance” (Ellis, 1973), which emphasize acknowledging and

accepting personal weakness and adopting an unconditionally caring stance toward oneself,

are largely consistent with the self-kindness dimension of self-compassion. However, self-

compassion extends beyond humanistic themes of focusing on the individuals by

incorporating a sense of shared humanity (i.e., common humanity) and a broad and balanced

perspective (i.e., mindfulness) into its conceptualization.

Self-compassion is closely related to both physical and mental health. Accumulating

research has showed its significant and positive associations with physical health (Raque-

Bogdan, Ericson, Jackson, Martin, & Bryan, 2011), life satisfaction, and positive affect, and

negative associations with negative affect, depression, and anxiety (Neff, 2003a; Neff,

Kirkpatrick, & Rude, 2007; Neff & Vonk, 2009). Self-compassion was also found to provide

significant additional variance on well-being above and beyond that provided by social

support (Neely, Schallert, Mohammed, Roberts, & Chen, 2009). Such findings suggested
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that self-compassion may play a distinct role in self-help intervention and promotes health

independently from social resources.

Self-Compassion and Emotion Regulation

Self-compassion has been regarded as a useful emotion regulation strategy when

encountering difficulties (Neff, 2003b). Possessing self-compassionate attitudes allows

individuals to bring awareness to their emotions, approach distress with kindness and

understanding, and have a sense of shared humanity. With a more adaptive approach to their

distress, individuals may gradually transform their negative emotions into more positive ones,

have a better understanding of situations, adopt more effective coping strategies to deal with

their stressors (Neff, 2003a, 2003b), and hence experience better outcomes.

Findings from empirical research supported the mediating role of emotion regulation

in the association between self-compassion and well-being. Correlational studies showed

significant and positive associations of self-compassion with emotional intelligence and

adaptive emotional processing (Heffernan, Griffin, McNulty, & Fitzpatrick, 2010; Neff,

2003a; Neff et al., 2005), and a study found that emotion regulation mediated the association

between self-compassion and stress (Finlay-Jones, Rees, & Kane, 2015). Experimental data

also showed self-compassion cultivating exercises (e.g., the “Gestalt two-chair” exercise,

compassionate mind training exercise, and mindful self-compassion program) could serve as

effective emotion regulation strategies, which led to significant increases in happiness,

reductions in emotional distress, depression and anxiety, and an enhanced ability to soothe

and reassure the self (Diedrich, Grant, Hofmann, Hiller, & Berking, 2014; Gilbert & Procter,

2006; Kelly, Zuroff, & Shapira, 2009; Neff & Gerner, 2013; Neff et al., 2007). All these

findings suggested that emotion regulation may be the mechanism underlying the health

benefits of self-compassion.

Writing Intervention
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Writing may be a cost-effective way to promote well-being among the Chinese by

facilitating self-compassion and emotional regulation capacities. Writing may be a cost-

effective way to promote well-being among the Chinese by facilitating self-compassion and

emotional regulation capacities. (e.g., Gilbert & Procter, 2006; Kelly et al, 2009; Neff et al.,

2007), which make them less feasible to serve as self-help tools. Expressive writing is a

widely examined self-help intervention (Frattaroli, 2006), which allows individuals a safe

context to acknowledge their feelings, and gradually understand, validate and accept them

(Greenberg & Lepore, 2004; Lepore et al., 2002). Through writing, individuals experience an

increase in emotional intelligence and emotional self-efficacy (Kirk, Schutte, & Hine, 2011),

especially when they are explicitly asked to reflect on emotion regulation in their writing

(Wing, Schutte, & Bryne, 2006). Previous studies showed that expressive writing is

particularly helpful for Chinese and Asian Americans (Lu & Stanton, 2010; Lu, Zheng,

Young, Kagawa-Singer, & Loh, 2012), probably because these ethnic groups have a low

tendency to seek mental health services (Chu, Hsieh, & Tokars, 2011; Nguyen & Lee, 2012)

and preference for self-help intervention over external professional help (Han & Pong, 2015)

due to stigmatization of mental illnesses in lay cultures (Lee, Lei, & Sue, 2000; Mak & Chen,

2010).

Therefore, adopting the methodology of expressive writing, self-compassion writing

may be a cost-effective way to promote self-compassion, emotion regulation and well-being

among Chinese. So far, only limited studies have examined the benefits of self-compassion

writing (e.g., Baum & Rude, 2013; Imrie & Troop, 2012; Leary et al., 2007; Odou & Brinker,

2014). Among them, only two experimental studies have explicitly induced all three

components of self-compassion in the writing paradigm (Leary et al., 2007; Johnson &

O’Brien, 2013), and none of them were conducted with Chinese or Asian participants. In the

first self-compassion writing study, participants were asked to identify a personally

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experienced negative event that made them feel bad about themselves (Leary et al., 2007).

Three prompts were given to the self-compassion writing group, with each prompt focused on

one component of self-compassion (i.e., self-kindness, common humanity, and mindfulness).

Specifically, participants were asked to list ways in which other people also experience

similar events (to promote common humanity), to express understanding, kindness, and

concern to themselves in the same way that they might comfort to a friend who had

undergone the same experience (to promote self-kindness), and to describe their feelings

about the experience in an objective and unemotional fashion (to promote mindfulness).

Results showed that the self-compassion writing group reported significantly lower levels of

post-writing negative affect than the typical expressive writing group. These results

replicated a study by Odou and Brinker (2014), which suggested that guiding individuals to

adopt a self-compassionate attitude soon after a distressing event may provide them timely

relief from negative emotions and hence promote adaptive emotional processing. Later,

Johnson and O’Brien (2013) adopted the writing prompts developed by Leary et al (2007)

and replicated the study to examine the effect of repeated self-compassion writing (three

times a week). They found participants in the self-compassion writing group reported

significant reduction in shame-proneness and depressive symptoms at the 2-week follow-up,

while no significant changes were reported by the standard expressive writing group or the

control group. These findings suggested that self-compassion writing had a stronger effect in

eliminating the negative mood associated with distressing events and facilitating emotion

regulation than typical expressive writing.

Nevertheless, it should be noted that the self-compassion writing paradigm used in these

two studies may not exactly resemble the conceptualizations of self-compassion components

defined by Neff (2003a, 2003b); specifically, the writing prompts seem to over-simplify the

concepts of common humanity and mindfulness. Common humanity is not limited to

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reflecting on how others may experience similar events, but also acknowledges suffering and

failures as a shared part of the human experience. While mindfulness involves a balanced

approach to individuals’ thoughts and feelings, it is not tantamount to processing the events

in an unemotional way, which can lead to emotion suppression. Instead of ignoring the

emotional aspects of a distressing experience, mindfulness is about bringing awareness to

emotions in an accepting and non-judgmental manner, without suppression or exaggeration.

Although the three self-compassion components were not specified in the writing paradigm

used in their study, Baum and Rude (2013) developed writing instructions adapted from self-

compassion and mindfulness interventions (Leary et al., 2007; Segal, Williams, & Teasdale,

2002) that implicitly capture the concepts of self-kindness (e.g., express the same sort of

kindness, understanding, and compassion towards yourself as you would towards someone

you really care about), common humanity (e.g., remember that part of the human experience

includes experiencing difficult feelings about distressing events) and mindfulness (e.g., try to

bring curiosity to your experience and be accepting of any emotions or thoughts that arise).

Results showed that depression-prone individuals who wrote in this self-compassion writing

paradigm tended to report less depressive symptoms than those in the control condition who

wrote objectively (i.e., without emotion) about how they spent their time, suggesting self-

compassion writing may be beneficial to psychological well-being.

Neff (2009), the developer of the self-compassion scale, also created a self-compassion

journal exercise with a more comprehensive writing paradigm on the three self-compassion

components than the one used by Baum and Rude (2013). However, as far as research that

can be accessed, this writing paradigm has not been tested in any empirical studies, and thus

its effectiveness on health improvement is yet to be examined. Further research is needed to

investigate the health benefits of self-compassion writing, which provides a comprehensive

writing instruction that could thoroughly illustrate and guide individuals to write on the three
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components of self-compassion, and facilitate emotion regulation. Also, the self-compassion

writing paradigm has never been examined among Asians, who tend to have a higher level of

emotion suppression (Butler, Lee, & Gross, 2007; Soto, Perez, Kim, Lee, & Minnick, 2011)

and a lower level of self-compassion (Neff, Pisitsungkagarn, & Hseih, 2008) than their

Caucasian counterparts. Therefore, it is worthwhile to further explore whether the benefits of

repeated self-compassion writing can be extended to promote psychological and physical

well-being among Chinese individuals.

Aims of the Present Study

The present study attempted to test the effectiveness of self-compassion writing and

its potential driving mechanisms (i.e., self-compassion and emotion regulation). The two

aims of the present study were: (1) to examine the effect of self-compassion writing on post-

writing mood as well as psychological and physical health among Hong Kong Chinese, and

(2) to examine the underlying mechanism of self-compassion writing.

Writing about negative experiences may cause temporary emotional disturbances and

short-term emotional costs, but later health benefits were expected (Pennebaker & Beall,

1986). Therefore, it was hypothesized that group differences would be observed in positive

and negative affect across the three days of writing, but improvement in psychological and

physical health would appear at follow-up assessments. In particular, lower levels of positive

affect and higher levels of negative affect were expected in the self-compassion writing group

than the control writing group immediately after writing, but more reduction of depressive

and physical symptoms for the self-compassion group than the control group at the 1-month

and 3-month follow-ups. Furthermore, in line with the literature and empirical findings that

emotion regulation is the mechanism underlying the health benefits of self-compassion

(Finlay-Jones, Rees, & Kane, 2015; Neff, 2003a, 2003b), we expected that the self-

compassion writing group would experience more improvements in self-compassion

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components and emotion regulation capacities at follow-ups than the control writing group.

Also, we expected that these improvements in self-compassion components and emotion

regulation capacities would mediate the condition effect on the reducing of depressive and

physical symptoms.

Method

Participants

112 university students were recruited from the XXX University via mass mailing

in two cohorts (one in the spring semester, the other in the summer semester). Data from 47

participants were excluded: 5 dropped out after baseline assessment and did not participate in

the writing intervention, 2 were outliers with multiple scores beyond 3 SD, and 40

participants dropped out at 3-month follow up assessment (20 from the self-compassion

writing group and 20 from the control writing group). No participants dropped out at 1-

month follow-up assessment. As a result, the data of 65 participants (30 men and 35 women;

mean age = 20.5, SD = 1.43) were retained for analysis. There were 33 participants in the

self-compassion writing condition (mean age = 20.70, SD = 1.43; 17 men and 16 women)

and 32 participants in the control writing condition (mean age = 20.31, SD = 1.42; 13 men

and 19 women). Among the participants, 35.6% were freshmen, 26% were sophomores,

20.2% were juniors, 6.8% were senior, and 11.5% were graduate students; the majority were

social sciences (26.9%) and sciences (20.2%) students, followed by arts (15.4%), engineering

(12.5%) and business (11.5%) students. Most students did not have a religion (78.8%), and

some of them self-identified as Christians or Catholics (17.3%).

Procedures

The present study adopted a mixed research design, with writing condition as the

between subject variable and time of assessments as the within subject variable. The entire

study was implemented on the Internet platform. Participants completed the baseline
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assessment one week before the writing sessions. Then, stratified by gender, participants

were randomly assigned to one of the two conditions: self-compassion writing and control

writing. Both experimenter and participants were blind to the condition assignment.

The first writing session took place in the laboratory. A briefing session was given to

the participants, in which experimenter explained the study procedure and provided a list of

suicide prevention hotlines and contact information of counseling centers. Participants then

entered into an individual room and logged into websites that contained writing instructions

specified for their assigned conditions. Participants were asked to follow the writing

instructions and type in the textbox(es) in their native Chinese language (three designated

textboxes in the self-compassion writing condition, one textbox for each self-compassion

component in the order of mindfulness, common humanity and self-kindness; one designated

textbox in the control writing condition; Andersson & Conley, 2013; Seih, Chung, &

Pennebaker, 2011). Sessions were timed such that a pop-up screen would appear when time

was up, and participants were automatically logged off from the website. A restriction was

also set such that participants could not submit their text until 20 minutes had passed.

Disclosing negative events can be a difficult and upsetting process, which typically results in

short-term distress (Smyth, 1998). Therefore, it is a common practice to assess the short-term

emotional cost of emotional disclosure in expressive writing research (Pennebaker & Beall,

1986; Smyth, 1998). In this study, immediately after the writing session, participants were

asked to complete a brief measurement on mood (i.e., Positive and Negative Affect Schedule,

PANAS). Participants completed their writing and mood assessment in three consecutive

days. After the first laboratory writing session, they completed the second and the third

online writing sessions at home or any private space as they preferred. One month and three

months after the final writing session, participants completed the follow-up assessments. The
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study has been approved by the Survey and Behavioral Research Ethics Committee of XXX,

and XXX Clinical Research Ethics Committee.

Writing Conditions and Instructions

Self-compassion writing. Participants followed the same writing instruction each day.

Based on the self-compassion journal exercise developed by Neff (2009) and the self-

compassion induction exercise developed by Leary et al. (2007), a modified writing

instruction was created and used in the present study. Participants were asked to write about

a recent event that was painful or they felt bad, or any time that they had judged themselves,

and then to use an accepting and self-compassionate attitude to process the experience.

Three prompts, each centered on the concept of mindfulness, common humanity and self-

kindness, were given to participants (see Appendix).

Control writing. Previous research suggested that asking control participants to write

on neutral and trivial topics (e.g., description of your living room) may cause a control group

deterioration effect, and that having participants to write about their daily activities in a

factual and unemotional manner maybe a more appropriate control (Radcliffe, Lumley,

Kendall, Stevenson, & Beltran, 2007). As such, control participants in the present study were

asked to write about their daily activities in factual and unemotional manner: Day 1, what

they did over the last week; Day 2, what they did over the last 24 hours; Day 3, what they

plan to do over the coming 24 hours.

Measures

All measures used in this study are Chinese. When available, the Chinese version of

measures was used. Measures lacking an available Chinese version in current literature,

namely the Cohen-Hoberman Inventory of Physical Symptoms (Cohen & Hoberman, 1983)

and the Trait Meta-Mood Scale (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995), were

translated into Chinese using the backward translation method (Brislin, 1970) by two
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independent translators who are bilingual in Chinese and English. Discrepancies were

reconciled before the translation was used.

Mood. The 20-item Positive and Negative Affect Schedule (PANAS; Watson, Clark, &

Tellegen, 1988) was used to measure individuals’ levels of positive and negative mood states

immediately after each day of writing to capture participants’ momentary changes of mood

due to writing. Participants rated themselves on a 5-point scale from (1) very slightly or not at

all to (5) very much. In the present study, Cronbach’s alphas of positive affect across the

three days of writing ranged from .84 to .90, and Cronbach’s alphas of negative affect across

the three days of writing ranged from .88 to .91.

Depressive symptoms. The 10-item Centre for Epidemiological Studies Depression

Scale (CES-D; Irwin, Artin, & Oxman, 1999) was used to measure individuals’ level of

depression. Participants rated themselves on a 4-point scale from (0) rarely or none of the

time to (3) most or all of the time. In the present study, Cronbach’s alphas at the baseline and

the follow-up assessments ranged from .81 to .85.

Physical symptoms. The 33-item Cohen-Hoberman Inventory of Physical Symptoms

(CHIPS; Cohen & Hoberman, 1983) was used to measure individuals’ level of common

physical symptoms including sleep problems, constant fatigue, stuffy head or nose, acid

stomach or indigestion and poor appetite. Participants used a 5-point scale ranged from (0)

not at all to (4) extremely to indicate the degree to which the symptom has bothered them in

the past week. In the present study, Cronbach’s alphas at the baseline and the follow-up

assessments ranged from .85 to .93.

Self-compassion. The Self-Compassion Scale (SCS; Neff, 2003a) was used to assess

self-compassion in three dimensions, including self-kindness (versus self-judgment),

common humanity (versus isolation) and mindfulness (versus over-identification). Given

that our interest was to examine how self-compassion writing may promote self-compassion
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qualities that facilitate emotion regulation, only the positive subscales of SCS were analyzed

in the present study. The 13 items assessed individuals’ acts toward themselves at difficult

times; participants indicated how often they behave in the stated manner on a 5-point scale

ranged from (1) almost never to (5) almost always. In the present study, Cronbach’s alphas

of the subscales at the baseline and 1-month follow-up assessment ranged from .72 to .87.

Emotion regulation. The 30-item Trait Meta-Mood Scale (Salovey, Mayer, Goldman,

Turvey, & Palfai, 1995) was used to measure individuals’ ability to reflect upon and manage

their emotions. It consists of three subscales to measure different aspects of emotion

regulation: (1) attention – the degree of attention devoted to personal feelings; (2) clarity –

the clarity of feelings experienced; and (3) repair – the ability to regulate mood states.

Participants rated themselves on a 5-point scale from (1) strongly disagree to (5) strongly

agree, with higher scores indicating better emotion regulation skills. In the present study,

Cronbach’s alphas of subscales at the baseline and 1-month follow-up assessment ranged

from .71 to .84.

Demographic information. Participants provided demographic information including

age, gender, and level of education.

Manipulation check. To determine whether participants in the self-compassion writing

group had engaged in the condition-specific writing instruction, the writing content was

analyzed with the Linguistic Inquiry and Word Count program (LIWC2007; Pennebaker,

Chung, Ireland, Gonzales, & Booth, 2007). Related word categories were examined,

including positive and negative emotion words, causation words, and insight words. Text

analysis is a standard procedure to show that emotional and cognitive processing was

involved during writing, and it is a method commonly adopted by expressive writing

researchers (e.g., Guastella & Dadds, 2006; Warner et al., 2006).

Data Analysis
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Analyses were carried out in several stages. First, tests of baseline equivalence and

attrition analysis were carried out. Second, as manipulation check, the self-compassion

writing and the control group were compared on their average use of words across the three

days of writing. Third, the immediate effect of self-compassion writing and control writing

on mood, and their effect on psychological and physical health at follow-ups were examined.

Finally, to explain the potential mechanisms of self-compassion writing, the effect of self-

compassion writing on self-compassion components and emotion regulation capacities were

examined, to evaluate the mediating roles of self-compassion and emotion regulation in the

effect of self-compassion writing on depressive and physical symptoms.

Results

Baseline Equivalence

The completers in the self-compassion writing group and the control writing group were

compared to determine the success of randomization. Independent-samples t-tests and chi-

square test were conducted. Given that the scores of physical symptoms were positively

skewed (skewness ranged from 1.43 to 2.26), log transformation was applied to the scores,

and the transformed scores were then used in analysis. The two groups did not differ on

demographic information (all ps > .28) or variables of interest (i.e., depressive symptoms,

physical symptoms, self-compassion components and emotion regulation capacities) at

baseline (ps > .09).

Attrition Analysis

The completers and non-completers of writing were compared. Independent-samples t-

tests and chi-square test were conducted. The two groups did not differ on demographic

information (ps > .06) and variables of interest at baseline (ps > .09).

Manipulation Check
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The writing content of the self-compassion writing group and the control group was

compared by examining the average percentage use of words across the three days of writing.

Results of independent-samples t-tests showed significant group differences in the pattern of

word use. The self-compassion writing group wrote significantly more positive emotion

words (e.g., love, nice, sweet), negative emotion words (e.g., hurt, ugly, nasty), causation

words (e.g., because, effect, hence) and insight words (e.g., think, know, consider) than the

control group (see Table 1).

Immediate Effects of Writing on Mood

Repeated measure Analyses of Variance (ANOVAs) by mood (positive vs. negative),

time (D1, D2, vs. D3) and condition (self-compassion writing vs. control) were conducted to

examine the between-group differences in positive affect and negative affect immediately

following each writing session. Cohort of participant recruitment (spring semester vs.

summer semester) was added as a covariate in the analysis because previous study showed

that baseline stress would influence the effectiveness of writing intervention (Arigo & Smyth,

2012), and participants recruited in the spring semester may have more academic stressors

and workload than those in the summer semester and thus respond differently to the writing

intervention.

The three way interaction of mood x time x condition was not significant, F (2, 124) =

0.37, p = .69, but a significant interaction effect was found between mood and condition, F

(2, 62) = 9.54, p < .001. Participants in the self-compassion writing condition tended to

report lower levels of positive affect and higher levels of negative affect than the control

group (see Table 2).

Effects of Writing on Psychological and Physical Health

Depressive symptoms. Repeated measure ANOVA by time (baseline, 1-month follow-

up, 3-month follow-up) and condition (self-compassion writing vs. control) was conducted to
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examine the between-group differences in depressive symptoms across time, with the cohort

of participant recruitment controlled. Results showed the interaction effect between time and

condition was not significant, F (2, 124) = 0.94, p = .39 (see Table 3).

Physical symptoms. Repeated measure ANOVA by time (baseline, 1-month follow-up,

3-month follow-up) and condition (self-compassion writing vs. control) was conducted to

examine the between-group differences in physical symptoms across time, with the cohort of

participant recruitment controlled. The interaction effect between time and condition was

marginally significant, F (2, 113.09) = 2.81, p = .07,η2p = .04. Specifically, the interaction

effect between time and condition was significant at 3-month follow-up, F (1, 62) = 4.03, p <

.05,η2p = .06, but not significant at 1-month follow-up, F (1, 62) = 3.03, p = .09, η2p = .05. To

follow-up the interaction effect between time and condition, repeated measure ANOVA was

conducted in each condition separately. A significant main effect of time was found in the

self-compassion writing condition, F (2, 30) = 4.89, p < .05, η2p = 0.25. Participants reported

a significant drop in physical symptoms from baseline to 1-month follow-up, F(1, 31) = 9.88,

p < .01, η2p = .24, and 3-month follow-up, F(1, 31) = 6.86, p < .05, η2p = .18. However, the

time effect was not significant in the control writing condition, F (2, 29) = 1.43, p = .26.

Participants reported no significant decrease in physical symptoms from baseline to 1-month

follow-up, F(1, 30) = 0.81, p = .38, and 3-month follow-up, F(1, 30) = 2.91, p = .10 (see

Table 3).

To determine whether the participant drop out at 3-month follow-up may contaminate

the findings, a repeated measure ANOVA by time (baseline vs. 1-month follow-up) and

condition (self-compassion writing vs. control) was also conducted with baseline and 1-

month data only (including data from participants who dropped out at the 3-month follow-up

assessment). Similar to the findings with 3-month data, results showed the interaction effects

between time and condition on depressive symptoms, F (1, 102) = 0.00, p = .95, and physical
SELF-COMPASSION WRITING 18

symptoms, F (1, 102) = 1.39, p = .24, were not significant, but the trend of reduced physical

symptoms in the self-compassion writing group at 1-month follow-up, F(1, 51) = 10.61, p

< .01, was similar to the findings with 3-month data that participants in the self-compassion

writing condition reported.

Effects of Writing on Self-Compassion and Emotion Regulation

Self-Compassion. A repeated measure MANOVA by time (baseline, 1-month follow-up,

3-month follow-up) and condition (self-compassion writing vs. control) was conducted to

examine the between-group differences in self-compassion components (i.e., self-kindness,

common humanity, and mindfulness) across time, with the cohort of participant recruitment

controlled. Results showed the interaction effect between time and condition on self-

compassion components was not significant, F (6, 252) = 0.41, p = .87 (see Table 3).

Emotion regulation. A repeated measure MANOVA by time (baseline, 1-month

follow-up, 3-month follow-up) and condition (self-compassion writing vs. control) was

conducted to examine the between-group differences in emotion regulation capacity (i.e.,

attention, clarity, and repair) across time, with the cohort of participant recruitment

controlled. Results showed the interaction effect between time and condition on emotion

regulation capacity was not significant, F (6, 248) = 0.52, p = .79 (see Table 3).

To examine whether the participant drop out at the 3-month follow-up assessment may

change the findings, repeated measure MNOVA by time and condition was also conducted

with baseline and 1-month data only. Similar to the findings with 3-month data, results

showed the interaction effects between time and condition on self-compassion components, F

(3, 101) = 0.20, p = .90, and emotion regulation capacities, F (3, 101) = 0.57, p = .64, were

not significant. On the other hand, as no significant improvement in self-compassion

components and emotion regulation capacities at the 1-month and 3-month follow-ups was

shown in the self-compassion writing group, no further analysis was carried out to examine
SELF-COMPASSION WRITING 19

the potential mediating roles of self-compassion components and emotion regulation

capacities in the effect of self-compassion writing on physical symptoms.

Discussion

The present study extended previous research by examining the effectiveness of self-

compassion writing among Chinese. It was expected that the self-compassion writing

paradigm could facilitate self-compassion and emotion regulation, which in turn lead to

health benefits.

The findings of the present study were in line with the hypotheses and previous research

that expressive writing resulted in emotional cost immediately after writing but health

benefits at later follow-ups (Pennebaker & Beall, 1986). The self-compassion writing group

reported significantly higher level of post-writing negative affect than the control writing

group. Nevertheless, a significant reduction in physical symptoms at the 1-month and 3-

month follow-up assessments was reported in the self-compassion writing group, while no

change in physical symptoms was reported in the control writing group. Although no

significant improvements in depressive symptoms were observed in the self-compassion

writing group or the control writing group, these results were consistent with previous meta-

analysis results that expressive writing has a weak impact on depression (r = .04, p < .05;

Frattaroli, 2006). Also, in line with previous research which suggested that Asians tend not

to report affective complaints because of the stigmatization of mental illness in Asian cultures

(for a review, see Lee, Lei, & Sue, 2000; Mak & Chen, 2010), the mean score of baseline

depressive symptoms in the present study was very low (approximately 10 out of 30). The

low score suggested that the majority of the participants reported they did not have frequent

depressive symptoms (“some or little of the time,” or “1-2 days during the week,” referring to

the anchors of the CES-D Scale) before the writing intervention. Hence, there was a potential
SELF-COMPASSION WRITING 20

floor effect, which made reduction in depressive symptoms by self-compassion writing less

feasible.

Self-compassion has been conceptualized as an emotion regulation strategy (Neff,

2003b; Odou & Brinker, 2014); therefore, the present study examined self-compassion and

emotion regulation as the underlying mechanism of self-compassion writing. However,

inconsistent with the hypothesis, the results showed no significant improvement in self-

compassion components and emotion regulation capacities at 1-month or 3-month follow up

assessments. Future study may consider including a post-intervention assessment on self-

compassion to examine potential short-term effect of writing on promoting self-compassion,

if not long-term. On the other hand, other research suggested that self-compassion is a

process that requires more time to occur (Shahar et al., 2012), and writing once each week

over a month may be more effective than writing four times within a single week

(Pennebaker, 1997). It is possible that 3-day self-compassion writing may not be sufficient in

promoting self-compassion and emotion regulation capacities at follow-up, and longer

writing practice is required. Moreover, it is possible that the small changes in self-

compassion and emotion regulation capacities may be better captured with more sensitive

measured, such as the Self-Compassion and Self-Criticism Scales (Falconer, King, & Brewin,

2015), the Assessing Emotions Scale (Schutte et al., 1998) or the Emotional Self-Efficacy

Scale (Kirk, Schutte, & Hine, 2008). It is also possible that self-compassion writing

promotes physical health with alternative mechanisms, such as reducing self-criticism and

promoting adaptive coping strategies, and further research is needed to examine this

speculation.

Limitations and Future Research Directions

There were several limitations in the present study. First, due to convenience sampling,

only Hong Kong Chinese college students were recruited in the present study. The writing
SELF-COMPASSION WRITING 21

task may elicit events that widely vary in psychological significance across individuals.

Meta-analysis found that a larger effect of expressive writing was revealed in community

samples and samples with existing physical health problems or trauma or stress history than

in university student samples (Frattaroli, 2006), future studies should extend the present study

to a greater diversity of samples, especially those who have adjustment difficulties or distress.

Second, some researchers suggested that having the ability to regulate emotions is not

equivalent to actual utilization of emotion regulation ability when facing problems, and

emotional self-efficacy may better reflect actual utilization of emotion regulation than trait

emotional intelligence (Kirk et al., 2011). Only the measurement of emotional intelligence

was included in the present study, which may limit our understanding of emotion regulation

as the mechanism of self-compassion writing. Future studies should consider including a

measurement of emotional self-efficacy to re-examine how self-compassion writing may

benefit health through enhancing individuals’ efficacy in regulating emotions. Lastly, the

present study did not examine possible moderators of self-compassion writing. It was

suggested that people with fear of emotions, impaired affect tolerance, and alexithymia may

benefit from emotion disclosure more than others (Greenberg & Lepore, 2004). The health

benefits of self-compassion writing may thus be more pronounced among these individuals.

Future studies may investigate whom self-compassion writing benefits most.

Notwithstanding these limitations, the findings of the present study are inspiring. It is one of

the first attempts to investigate the health benefits and mechanisms of self-compassion

writing among Chinese.

Conclusion

The present study was one of the few studies which attempted to examine the potential

health benefits of self-compassion writing among Chinese. It is premature to conclude that

self-compassion writing is an effective approach to promote well-being among Asians/ Asian

SELF-COMPASSION WRITING 22

Americans and further research is needed to support this argument. However, not requiring

any trained professionals, extensive knowledge, techniques or equipment, self-compassion

writing may be utilized as a cost-effective self-help intervention in promoting health among

the general public, especially for populations who do not have access to professional care

services (Kazdin & Blase, 2011), and those reluctant to seek mental health services, such as

Asian Americans (Chu, Hsieh, & Tokars, 2011).

With the prevalent cultural belief that any psychological problem is a result of

personality weakness or a lack of self-control and willpower (Kung, 2004), and the resulting

stigmatization of mental health problems in Asian societies, Asians and Asian Americans

tend not to express their emotional problems, and they find expression of psychological

distress through the body (i.e., somatization) more acceptable (Lee, Lei, & Sue, 2000; Mak &

Chen, 2010). Instead of seeking mental health services to deal with their problems, they

would prefer using self-help methods (Han & Pong, 2015). Self-compassion writing, a self-

help method that allows individuals to receive intervention (i.e., write about their distressing

experience) at their personal time and space, and without the disclosure of personal identity

and hence potential risk of stigmatization, may be an alternative approach to reach out to

Asians and Asian Americans.

SELF-COMPASSION WRITING 23

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