PLOS ONE RESEARCH ARTICLE Assessing self-criticism and self-reassurance: Examining psychometric properties and clinical usefulness of the Short-Form of the Forms of Self-Criticizing/Attacking & Self- Reassuring Scale (FSCRS-SF) in Spanish a1111111111 sample a1111111111 Jaime Navarrete1, Rocı́o Herrero ID1, Joaquim Soler2, Elisabet Domı́nguez-Clavé2,3, a1111111111 Rosa Baños1,4, Ausiàs Cebolla ID1,4* a1111111111 a1111111111 1 Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain, 2 Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain, 3 Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain, 4 CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain OPEN ACCESS * ausias.cebolla@uv.es Citation: Navarrete J, Herrero R, Soler J, Domı́nguez-Clavé E, Baños R, Cebolla A (2021) Assessing self-criticism and self-reassurance: Examining psychometric properties and clinical Abstract usefulness of the Short-Form of the Forms of Self- The Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) was designed Criticizing/Attacking & Self-Reassuring Scale (FSCRS-SF) in Spanish sample. PLoS ONE 16(5): to measure self-criticism (SC) through Inadequate Self (IS) and Hated Self (HS) factors, as e0252089. https://doi.org/10.1371/journal. well as self-reassurance (RS). However, its long and short forms have yet to be validated in pone.0252089 the Spanish Population. The present study examines the psychometric properties of the Editor: Peter M. ten Klooster, University of Twente, short form (FSCRS-SF) and its clinical usefulness in a sample of 576 adult individuals, 77 NETHERLANDS with psychiatric disorders and 499 without. Non-clinical participants were split according to Received: January 21, 2021 their previous experience with meditation (active meditators, n = 133; non-active meditators, Accepted: May 7, 2021 n = 41; and non-meditators, n = 325) and differences between these subgroups were explored. Additionally, a subsample of 20 non-clinical participants took part in a mindful- Published: May 24, 2021 ness- and compassion- based intervention (MCBI) to assess the usefulness of the scale as Copyright: © 2021 Navarrete et al. This is an open an outcome measure. Results confirmed the original three-factorial structure, good internal access article distributed under the terms of the Creative Commons Attribution License, which consistency, acceptable test-retest reliability, and a pattern of correlations consistent with permits unrestricted use, distribution, and previous literature. Regarding differences between groups, the clinical subsample showed reproduction in any medium, provided the original significant higher SC and lower RS levels than non-clinical participants and active medita- author and source are credited. tors had significant lower IS and higher RS levels than non-meditators. Participants who par- Data Availability Statement: All relevant data are ticipated in the MCBI showed significant RS improvement and a decrease in IS and HS within the paper and its Supporting Information levels. Moreover, a hierarchical multiple regression showed that RS made a significant pre- files. dictive contribution to distress at three months’ time. In conclusion, results show that the Funding: This work was supported by Ministerio Spanish version of the FSCRS-SF is a reliable and valid measure of SC and RS in non-clini- de Economı́a y Competitividad (Spain) under AMABLE-VR (RTI2018-097835-A-I00). cal populations and an adequate instrument to detect changes after MCBIs. Competing interests: The authors have declared that no competing interests exist. PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 1 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF Introduction Motivated by the desire to overcome the limitations of disorder-specific therapies, the trans- diagnostic approach is gaining relevance in regard to treating mental health problems [1–4]. According to the transdiagnostic model, emotional disorders (i.e., depressive and anxiety disor- ders) have common aspects or factors underlying the symptomatology [5]. In this framework, self-criticism (SC) belongs to the family of intrusive or repetitive thoughts, and has been identi- fied as a vulnerability factor for psychopathology and a transdiagnostic process of many mental health problems [6]. It underlies the development and maintenance of depressive [7–11], anxi- ety [12,13], and psychotic symptoms [14], eating disorders [15–18], non-suicidal self-injury [19], and suicidality [20,21]. Furthermore, SC also interacts with the evolution of the treatment, given that higher levels of baseline patients’ SC predict less symptom reduction [22]. The cognitive-evolutionary approach proposed by Gilbert [23] suggests that SC is a form of interaction between self-parts, which involves constantly expressing intense hostility and disre- spect from a part of the self towards another. According to this model, SC can take the form of a sense of internal inadequacy because of mistakes (Inadequate Self), or an aggressive/destruc- tive/pathological response to the self after failure (Hated Self). These forms of SC are the result of an apparent desire for self-improvement or the persecution of oneself as a form of personal revenge [24]. Moreover, Gilbert et al. [24] defined self-reassurance as an adaptive self-to-self interaction, specifically as the ability to bring kindness, caring, and peacefulness to the self when things go wrong. This self-reassurance ability is highly correlated to compassion [25], since both are adaptive forms of relating to the self in the context of difficult life struggles. In addition, self- reassurance seems to be an independent factor, instead of the opposite end of a SC dimension, according to several factor-analytic and fMRI studies [19,26,27]. Finally, it is a buffer against the development of psychopathology and fosters well-being [28–31]. Compassion is rooted in a care-giving mentality and is subject to change by mind-training procedures, which in turn reduces SC by developing a compassionate understanding of one’s situation [32]. Hence, SC has been used as an outcome for different interventions, especially those that include loving-kindness and compassion meditations [e.g., 33–37]. These medita- tions are part of the ‘relation orientation’ constructive family, which aim to strengthen healthy psychological patterns by nurturing prosocial qualities [38]. Similarly, cultivation of atten- tional regulation mechanisms (mindfulness) improves attention, body awareness (ability to focus on internal sensory experiences), reappraisal (positive reconstruction of stressful events), non-reactivity (non-reactive response to inner experience), and a detached perspective of the self [39,40]. Thus, attentional and constructive meditation practice leads to low levels of SC [23,41], though little is known about the evolution of SC over time, after decreasing or aban- doning the meditation practice. Based on the different models, researchers have developed several self-report questionnaires to assess SC, though to the best of our knowledge none of them have ever been validated to Spanish. Rose and Rimes [42] developed a systematic review to evaluate their measurement properties. These authors only recommended the use of the Forms of Self-Criticizing/Attack- ing and Self-Reassuring Scale [24] and the Self-Critical Rumination Scale [43] in future research taking into account their good psychometric properties and the high methodological quality of their validation studies. Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) Gilbert et al. [24] developed the 22-item FSCRS to focus on the concrete forms in which people engage in self-attacking behaviors when things go wrong for them, which previous PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 2 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF instruments have failed to measure. They confirmed the Inadequate Self (IS) and the Hated Self (HS) factors and included a subscale for measuring the Reassured Self (RS). These three factors showed excellent reliability (IS Cronbach’s α = 0.90, HS Cronbach’s α = 0.86, and RS Cronbach’s α = 0.86). In subsequent years, FSCRS has shown to be robust and reliable in both clinical and non- clinical populations in a range of different countries [44–48]. For instance, it has been used in the diagnosis of patients with borderline personality disorder (BPD) to examine the potential relationship between SC and recovery [49] and to evaluate the effects of a compassion-based intervention [33]. Furthermore, the FSCRS has been used to explore the phenomenology of SC in patients with eating disorders (ED) [e.g., 50,51] and SC proved to be a strong predictor of eating disorder symptoms [15]. Recently, a 14-item version (FSCRS-SF) was generated to minimize response burden and increase response rates in studies that require multiple assessments [52]. Sommers-Spijkerman et al. [52] tested its psychometric properties in a Dutch community sample and the three-fac- tor model of the full FSCRS was replicated. The short form demonstrated acceptable internal consistency. Nevertheless, test-retest reliability was not acceptable for IS and HS scores, in con- trast to the findings of Castilho et al. [44] with the full FSCRS. Moreover, the characteristics of the sample hinder generalization of the findings due to an underrepresentation of males and people with lower educational levels. Finally, the short form was not used as a stand-alone instrument as the extended version was. To this day, the study of Sommers-Spijkerman et al. [52] is the only one that has tested psychometric features of the short form. Spanish validation of the forms of Self-Criticizing/Attacking and Self- Reassuring Scale-Short Form In the present moment, neither the full nor the short form of the FSCRS has been validated in the Spanish population. Given that the study of Sommers-Spijkerman et al. [52] shows similar psychometric properties between both forms, the current study aims to translate and validate the 14-items FSCRS into Spanish in a large sample. The main reason to validate the shortened version of the FSCRS is to facilitate the assessment of SC and RS in research contexts, in which multiple measures are commonly used. The validity of the FSCRS-SF for discriminating between non-clinical and clinical samples. Moreover, we aimed to assess the additional utility of using FSCRS-SF for predicting a global mental health index, studying its potential role as a mediator between meditation practice and distress, and its usefulness as an outcome measure after a mindfulness- and compassion- based intervention (MCBI). We collected data from three samples of participants, including a non-clinical sample com- posed of frequent meditators, non-active meditators, and non-meditators, a clinical sample of patients with BPD and patients with ED, and a social worker sample. Firstly, factor structure was evaluated in the non-clinical sample; we hypothesized that the three-factor model would show adequate fit as well as it did in the Dutch population. Secondly, we expected similar evi- dence of its reliability and construct validity in the non-clinical sample compared to both the full and short original versions. That is, SC factors were expected to be positively associated with self-critical thinking, depression, anxiety, and somatization symptoms and negatively associated with self-compassion. Conversely, RS was expected to show a negative association with self-critical thinking and psychopathology symptoms, and a positive association with self- compassion. Reliability was also studied in the clinical sample. The third hypothesis stated that non-clinical participants who meditate will show significantly lower levels of IS and higher RS than both those who have meditation experience but did not practice during the last year and non-meditators. Regarding this hypothesis, we did not expect differences in HS scores among PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 3 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF these non-clinical subgroups because the HS subscale may not distinguish between non-clini- cal test-takers [45]. However, we expected that the clinical sample of BPD and ED patients would show significantly higher SC, especially HS levels, and lower RS than the non-clinical sample. We expected that the FSCRS-SF factors would significantly predict distress at three months’ time in the non-clinical sample, would mediate the effects of meditation practice on non-clinical participants’ general distress, and finally that the scale would be able to detect sig- nificant improvements in SC and RS after an MCBI in the social worker sample. Materials and methods Participants The Ethics Committee of Research in Humans of the Ethics Commission in Experimental Research of the University of Valencia approved the procedure (H1539699805131). We obtained written consent from all participants involved in this study. The non-clinical sample was composed of 499 adults living in Spain (122 men and 377 women), ranging from 18 to 75 years of age (M = 31.08, SD = 12.55). From them, 22 males and 97 females, ranging from 18 to 67 years of age (M = 31.09; SD = 12.11), composed the subsample for the analysis of test-retest reliability. Adult patients diagnosed with BPD (n = 36) and ED (n = 41) were recruited at the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) and made up the clinical sample (4 men and 73 women), ranging from 17 to 65 years of age (M = 31.03, SD = 11.03). Finally, a sample of 20 social workers (all women) took part in a MCBI, their age ranged from 25 to 56 years of age (M = 39.65, SD = 8.29). Participant characteristics are listed in Table 1. Regarding the non-clinical sample, 174 reported some kind of previous meditation experi- ence whereas 325 reported no experience at all. More specifically, 133 were ‘active meditators’ (i.e., they meditate at least 2 or 3 times per month) and 41 ‘non-active meditators’ who had not practiced meditation during the last year. Procedure Participants were recruited among undergraduate students at the University of Valencia and Castellón (Spain), and throughout the autonomous community in general. The sample was Table 1. Sociodemographic characteristics of participants. Non-clinical sample Clinical sample Variable n % n % Gender Female 377 75.55 73 94.8 Male 122 24.45 4 5.2 Marital status Single 364 72.95 NA NA Married/partnered 99 19.84 NA NA Divorced/widowed 36 7.21 NA NA Highest educational level Middle school 26 5.21 12 15.58 High school/some college 51 10.22 37 48.05 University or post-graduate degree 415 83.17 28 36.36 Other 7 1.40 0 0 NA = Not available. https://doi.org/10.1371/journal.pone.0252089.t001 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 4 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF recruited through advertisements (online ads in social media sites and internet forums) and flyers announcing the study to university students after their classes. The assessment was conducted between September (2019) and March (2020). Those who were interested in partici- pating received an e-mail with a link to the online survey that was programmed on the Lime- Survey of the University of Valencia or a pen-and-paper questionnaire package. In total, 437 individuals completely filled out the battery and 62 filled it out partially (only the FSCRS-SF). Moreover, all of them received a second link to answer the FSCRS-SF (and psychopathology symptoms with BSI-18) 3 months after the assessment (119 participants). Additionally, BPD and ED outpatients from the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) were invited to voluntarily participate in the present study. Those who agreed answered the pen- and-paper survey in situ. Finally, a sample of 20 social workers participated in a blended-inter- net MCBI intervention and the FSCRS-SF was administered before and after this intervention. These participants were recruited from the College of Social Workers of Valencia. The MCBI was an 8-week program called Well-being training based on contemplative practices (WTCP; [53]). Based on contemplative positive psychology, understood as an “area of positive psychol- ogy that includes a range of techniques and conceptualizations developed by the contemplative sciences for the promotion of well-being through evidence-based strategies” [53] this training was developed to train skills that predict well-being supported by contemplative practices. The premise of the WTCP program is twofold: a) it is possible to train the skills and abilities to achieve a balanced and virtuous mind through the mental training involved in the practice of meditation and b) this process, in turn, will increase the probability of increasing one’s levels of psychological well-being. Each of these skills, based on Richard Davidson and Schuyler’s work [54], is developed throughout the WTCP program, generating different practices, tasks, and meditations. Measures Forms of Self-Criticizing/Attacking and Self-Reassuring Scale—Short Form (FSCRS-SF). Sommers-Spijkerman et al. [52] proposed a short version of the Forms of Self- Criticizing/Attacking and Self-Reassuring Scale (FSCRS). Permission from the original authors of the FSCRS-SF and The Compassionate Mind Foundation was obtained to reproduce and val- idate the FSCRS-SF into Spanish. Three independent English/Spanish speakers translated this 14-item short form to Spanish, and subsequently an independent native English speaker trans- lated it back to English. After discussing the discrepancies, the Spanish-language version was adapted until it was equivalent to the original FSCRS-SF. It comprises three independent scales (IS, HS, and RS) with five, four, and five items, respectively. Participants respond to statements, which ask about how they react ‘when things go wrong’, on a 5-point Likert scale ranging from 0 (Not at all like me) to 4 (Extremely like me). Higher scores indicate a greater sense of inade- quacy (score 0–20), self-hate (score 0–16), and self-reassurance (score 0–20). See final Spanish version of the questionnaire in the online supporting information section (S1 File). Self-Critical Rumination Scale (SCRS). The SCRS comprises 10 items and a 4-point Likert scale ranging from 1 (not at all) to 4 (very well) to assess SC [43]. We used an ad hoc Spanish-language version of the SCRS, which is in process of validation in a parallel study. The scale has a single-factor structure and showed excellent internal consistency [43]. Higher scores indicate a greater negative thinking that devaluates the self (score 10–40). The SCRS demonstrated excellent internal consistency (Cronbach’s α = 0.91; McDonald’s ω = 0.91) in the present sample. Self-Compassion Scale Short-Form (SCS-SF). The SCS-SF is a 12-item measure assess- ing self-compassion [55]. We used the Spanish validated version, which reported good internal PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 5 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF consistency [56]. Items are scored on a 5-point Likert scale from 1 (Almost never) to 5 (Almost always), and all scores are added to form a total score. We also calculated separate scores for the Positive (Self-Kindness, Common Humanity, and Mindfulness) and Negative (Self-Judge- ment, Isolation, and Over-identified) subscales following recent recommendations about the interpretation and scoring of the scale [57,58]. The SCS-SF demonstrated good internal consis- tency (Total score Cronbach’s α = 0.86, McDonald’s ω = 0.86; Positive Subscale Cronbach’s α = 0.78, McDonald’s ω = 0.79; Negative Subscale Cronbach’s α = 0.83, McDonald’s ω = 0.83) in the present sample. The Brief Symptom Inventory-18 (BSI-18). Depression, anxiety, and somatization symptoms were assessed using the 18-item version of the BSI [59]. Participants rate the fre- quency of depressive symptoms (BSI-D, 6 items, score 0–24), anxiety symptoms (BSI-A, 6 items, score 0–24), and somatization (BSI-S, 6 items, score 0–24) over the past week on a 5-point Likert scale from 0 (Not at all) to 4 (Always). Moreover, the questionnaire offers a global scale of general distress (BSI-T) ranging from 0 to 108. The BSI-18 has good dimen- sional structure and reliability in the Spanish population [60]. The internal consistency of the subscales (BSI-D Cronbach’s α = 0.88, McDonald’s ω = 0.89; BSI-A Cronbach’s α = 0.81, McDonald’s ω = 0.82; BSI-S Cronbach’s α = 0.83, McDonald’s ω = 0.83) and the global index (BSI-T Cronbach’s α = 0.93, McDonald’s ω = 0.93) have been found to be good. Data analysis Descriptive statistics, Confirmatory Factor Analysis (CFA), internal consistency, intercorrela- tions between FSCRS-SF subscale scores, test-retest reliability, convergent and divergent valid- ity, a one-way between-groups multivariate analysis (MANOVA), a paired-samples t-test, a hierarchical multiple regression, and mediation analyses were all calculated starting with the descriptive statistics of the items in the non-clinical and clinical samples (see Table 2). CFA and internal consistency were computed using JASP (Version 0.12.1) while test-retest, validity Table 2. Descriptive statistics of the FSCRS-SF items. Non-clinical sample (n = 499) Clinical sample (n = 77) Items M Mdn Md SD Skew Kurt M Mdn Md SD Skew Kurt 1 2.16 2 3 1.01 -0.20 -0.65 1.79 2 1 1.06 0.36 -0.55 2 1.27 1 1 1.11 0.57 -0.54 3.04 3 4 1.08 -1.10 0.71 3 2.05 2 3 1.12 -0.24 -0.81 1.45 1 1 1.12 0.52 -0.40 4 1.58 1 1 1.23 0.31 -1.01 3.13 4 4 1.06 -1.02 0.36 5 2.95 3 4 1.07 -0.90 0.06 1.32 1 0 1.14 0.42 -0.63 6 0.62 0 0 1.13 1.78 1.95 1.81 1 0 1.57 0.23 -1.52 7 0.46 0 0 0.90 2.02 3.33 2.23 2 4 1.44 -0.21 -1.35 8 3.10 3 4 1.07 -1.21 0.83 1.81 2 3 1.29 0.07 -1.19 9 0.91 1 0 1.11 1.15 0.48 2.16 2 2 1.38 -0.23 -1.07 10 1.09 1 0 1.13 0.92 0.06 2.58 3 3 1.20 -0.51 -0.57 11 0.70 0 0 1.01 1.51 1.60 2.21 2 4 1.54 -0.18 -1.46 12 1.19 1 1 1.07 0.69 -0.26 2.88 3 4 1.20 -0.70 -0.59 13 1.60 1 1 1.31 0.42 -1.01 3.47 4 4 0.82 -1.53 1.57 14 2.71 3 3 1.09 -0.55 -0.55 2.04 2 2 1.28 0.04 -1.02 FSCRS-SF = Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short Form. M = mean; Mdn = median; Md = mode; Skew = Skewness; Kurt = Kurtosis. Items scores ranging from 0 (not at all like me) to 4 (extremely like me). https://doi.org/10.1371/journal.pone.0252089.t002 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 6 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF analysis, MANOVA, multiple regression, and mediation analysis were conducted in IBM SPSS Statistics for Windows (Version 26). Factor structure. Factor structure was assessed with the data collected from the non-clini- cal sample. Regarding CFA, preliminary analysis was conducted to ensure no violation of the assumptions of normality, linearity, multicollinearity, and absence of outliers and residuals. Distribution of some item scores were significantly skewed or highly kurtotic, therefore the robust maximum likelihood method was employed to estimate the three-factor model that had been hypothesized. Several fit criteria were computed such as the χ2 statistic, the Standardized Root Mean Square Residual (SRMR), the Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Fit Index (TLI) to determine the good fit between the model and the data. Following Hu and Bentler’s [61] recommendations regarding cut-off criteria, we used the combination of the SRMR � 0.08, RMSEA � 0.06, and CFI and TLI close to 0.95 to determine good fit between the model and the data. Standardized factor loadings �.50 were considered acceptable and �.70 were considered strong [62]. Internal consistency and intercorrelations between FSCRS-SF subscale scores. To assess subscale reliability, internal consistency was assessed using Cronbach’s α [63] and McDonald’s ω [64]. Additionally, we calculated intercorrelations between the FSCRS-SF sub- scale scores using Pearson’s correlation coefficient. Both of them were assessed with the data collected from the non-clinical and clinical samples. Test-retest reliability and convergent and divergent validity. Test-retest reliability and convergent and divergent validity were assessed with the data collected from the non-clinical sample. Pearson’s correlation was used by correlating the FSCRS-SF scores with the SCRS, SCS-SF, BSI-18, and post-FSCRS-SF ones. Effect size guideline for interpreting small, medium, and large correlations were 0.15, 0.25, and 0.35, respectively [65]. Known-groups validity. A MANOVA was performed to investigate clinical differences in SC and RS. FSCRS-SF factors were the dependent variables. Data from the non-clinical and clinical samples were used. The independent variable had four levels: active meditators, non-active meditators, participants without meditation experience, and clinical partici- pants. We conducted post hoc analyses using Tukey Honestly Significant Difference (HSD) test to identify where the potential significant differences lie. Preliminary assumption test- ing was conducted to check for normality, linearity, univariate and multivariate outliers, homogeneity of variance-covariance matrices, and multicollinearity, with no serious viola- tions noted. Sensitivity to change. A paired-samples t-test was conducted to evaluate the impact of the MCBI intervention on social workers’ scores. Eta squared was the effect size statistical measure calculated for both MANOVA and t-test. It was interpreted following Cohen’s [66] guidelines: .01 (small effect), .06 (moderate effect), and .14 (large effect). Predictive validity. Hierarchical multiple regression was used to assess the ability of the FSCRS-SF measure to predict levels of non-clinical participants’ general distress (BSI-T), after controlling for the influence of baseline distress. Preliminary analyses were conducted to ensure no violation of the assumptions of normality, linearity, multicollinearity, and homoscedasticity. Mediation analysis. Multiple mediation analyses, or simultaneous mediation by multiple mediators, were carried out with the data collected from the non-clinical sample following the methodology described by Hayes [67] from the PROCESS macro (version 3.4.1), choosing model 4. Thus, we studied the FSCRS-SF factors role as mediators between meditation practice and BSI-T scores at baseline. The confidence interval (CI) for the indirect effect was a percen- tile bootstrap 95% interval based on 5000 samples. CI that did not contain the zero-value indi- cated a significant indirect effect. PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 7 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF Results Factor structure The hypothesized model with coefficients presented in standardized form is shown in Fig 1. It was tested and support was found for the three-factor model, χ2 (74, N = 499) = 238.13, p < .001, SRMR = 0.04, RMSEA = 0.06, CFI = 0.94, and TLI = 0.93. Factor loadings were accept- able, ranging from .56 to 1.03. Fig 1. Confirmatory factor analysis model of the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale- Short Form. https://doi.org/10.1371/journal.pone.0252089.g001 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 8 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF Table 3. Pearson intercorrelations and internal consistency of the FSCRS-SF subscales in clinical and non-clinical samples. Non-clinical sample (n = 499) Clinical sample (n = 77) FSCRS-SF subscales Inadequate self Hated self Reassured self Inadequate self Hated self Reassured self Inadequate - - - - - - self .73 - - .69 - - Hated self -.52 -.52 - -.63 -.67 - Reassured self Cronbach’s α .80 .80 .81 .79 .82 .80 McDonald’s ω .81 .81 .81 .80 .82 .82 FSCRS-SF = Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short Form. All correlations were significant at p < .01. https://doi.org/10.1371/journal.pone.0252089.t003 Internal consistency and intercorrelations between FSCRS-SF subscale scores Regarding reliability, the internal consistency of the FSCRS-SF subscales was adequate for both clinical and non-clinical samples (see Table 3). The intercorrelation of the three FSCRS-SF subscales were large for both non-clinical (|r| � .52) and clinical samples (|r| � .63). Table 3 shows Cronbach’s α, McDonald’s ω, and intercorrelations of the FSCRS-SF subscales. Test-retest reliability and convergent and divergent validity Test-retest reliability at 3 months was r = .78 for IS subscale, r = .73 for HS subscale, and r = .66 for RS subscale (all with p < .01), which supports temporal stability of FSCRS-SF scores. Table 4 shows correlations between FSCRS-SF with SCRS, SCS-SF, and BSI-18. All correla- tions were large, significant, and in the expected direction, supporting the convergent and divergent validity of the FSCRS-SF. Known-groups validity With the use of Wilks’ criterion, the combined FSCRS-SF factors were significantly affected by group condition, F (9, 1370.35) = 27.24, p < .001; Wilks’ Lambda = 0.67; η2 = 0.13. When the Table 4. Convergent and divergent validity of the FSCRS-SF scales. FSCRS-SF Measure M SD Inadequate self Hated self Reassured self SCRS Total score 20.94 7.23 .74�� .60�� -.43�� SCS-SF Positive subscale 18.26 5.01 -.49�� -.45�� .61�� �� �� Negative subscale 15.39 5.50 .78 .60 -.46�� �� �� Total score 38.88 9.14 -.74 -.61 .61�� BSI-18 Depressive symptoms 5.55 5.48 .60�� .59�� -.48�� Anxiety symptoms 5.01 4.62 .47�� .38�� -.35�� Somatization 3.86 4.62 .36�� .35�� -.28�� �� �� General distress 14.43 13.10 .55 .51 -.43�� N = 499. FSCRS-SF = Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short Form; SCRS = Self-Critical Rumination Scale; SCS-SF = Self-Compassion Scale Short-Form; BSI-18 = The Brief Symptom Inventory-18. �� p < .01. https://doi.org/10.1371/journal.pone.0252089.t004 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 9 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF Table 5. Means, standard deviations, and one-way analyses of variance in FSCRS-SF subscales. Measure Active meditators (n = 133) Non-active meditators (n = 41) Non-meditators (n = 325) Clinical sample (n = 77) F (3, 565) η2 FSCRS-SF Inadequate self 6.08 (4.07) 5.61 (3.77) 7.15 (4.52) 15.17 (3.99) 87.49��� .32 Hated self 2.47 (3.30) 2.02 (2.82) 2.88 (3.30) 8.47 (4.77) 60.68��� .24 ��� Reassured self 13.71 (4.01) 13.83 (3.47) 12.59 (4.03) 8.39 (4.42) 31.49 .14 All values represent mean scores (standard deviations in parenthesis); FSCRS-SF = Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short Form. For non- clinical sample (i.e., active, non-active, and non-meditators): IS (M = 6.73; SD = 4.37); HS (M = 2.70; SD = 3.27); RS (M = 12.97; SD = 4.01). ��� p < .001. https://doi.org/10.1371/journal.pone.0252089.t005 results for the dependent variables were considered separately, there were statistically signifi- cant differences in IS, HS, and RS (see Table 4). Post hoc comparisons using the Tukey HSD test indicated that the clinical sample had statistically significant higher IS (p < .001) and HS (p < .001) and lower RS (p < .001) mean scores than all non-clinical subgroups. Moreover, there were statistically significant differences in IS (p = .013) and marginally significant differ- ences in RS (p = .050) between the mean scores of active meditators and participants without meditation experience. Table 5 shows means, standard deviations, and one-way analyses of variance in FSCRS-SF factors. Sensitivity to change Regarding the subsample (n = 20) that underwent the MCBI, there was a statistically signifi- cant decrease in IS scores from Time 1 (M = 7.40, SD = 3.57) to Time 2 (M = 5.80, SD = 2.48), t (19) = 2.20, p = .04 (two-tailed) with eta squared (.20) indicating a large effect size. In terms of HS, there was no statistically significant decrease in scores from Time 1 (M = 1.75, SD = 1.48) to Time 2 (M = 1.25, SD = 1.16), t (19) = 1.75, p = .096 (two-tailed) and eta squared (.14) indi- cated a large effect size. Finally, there was a statistically significant increase in RS scores from Time 1 (M = 13.50, SD = 3.28) to Time 2 (M = 15.80, SD = 2.91), t (19) = -3.19, p = .005 (two- tailed) with eta squared (.35) indicating a large effect size. Predictive validity Table 6 shows the regression coefficients for the hierarchical multiple regression. BSI-T base- line scores were entered during Step 1, explaining 49.5% of the variance in general distress Table 6. Hierarchical regression results for global index of general distress at three months’ time. Model Scales B SE β t p Step 1 Constant 4.65 1.35 3.44 .001 BSI-T (baseline) 0.73 0.07 0.70 10.47 .000 Step 2 Constant 12.47 4.72 2.64 .009 BSI-T (baseline) 0.73 0.08 0.62 7.61 .000 FSCRS-SF (Inadequate self) 0.19 0.32 0.06 0.59 .560 FSCRS-SF (Hated self) -0.19 0.42 -0.05 -0.46 .650 FSCRS-SF (Reassured self) -0.58 0.27 -0.17 -2.07 .041 BSI-T = Brief Symptom Inventory Total Score; FSCRS-SF = Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short Form. https://doi.org/10.1371/journal.pone.0252089.t006 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 10 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF Fig 2. Influence of meditation practice on general distress through self-criticism. IS = Inadequate self; HS = Hated self; RS = Reassured self. a = Meditators vs. non-meditators. b = Non-active Meditators vs. non-meditators � p < .05. �� p < .01. ��� p < .001. https://doi.org/10.1371/journal.pone.0252089.g002 scores at three months’ time. After entering the IS, HS, and RS factors, the total variance explained by the model as a whole was 52% F (4, 109) = 29.55, p < .001. The SC measures explained an additional 2.6%, after controlling for baseline scores, R squared change = .026, F change (3, 109) = 1.95, p = .126. In the final model, RS was the only FSCRS-SF factor to reach statistical significance with a beta = –.17 (p = .041). Mediation analysis As can be seen in Fig 2 and Table 7, participants who actively meditate, even those who did not practice during the last year, reported a lower distress level than participants without medi- tation experience, mediated by IS and RS levels. There was no evidence that active/non-active meditators and those without meditation experience influenced baseline BSI-T scores inde- pendent of its effect on IS and RS. Table 7. Mediation analysis: Indirect effects of meditation on distress through self-criticism and self-reassuring. 95% CI Antecedent Mediator Coeff. SE LL UL Active meditators IS -1.07 0.54 -2.23 -0.09 vs HS -0.17 0.27 -0.76 0.33 Non-meditators RS -0.59 0.33 -1.33 -0.02 Non-active meditators IS -1.67 0.72 -3.19 -0.34 vs HS -0.57 0.37 -1.39 0.03 Non-meditators RS -0.88 0.47 -1.94 -0.09 IS = Inadequate self; HS = Hated self; RS = Reassured self; SE = standard error; CI = confidence interval; LL = lower limit; UL = upper limit. https://doi.org/10.1371/journal.pone.0252089.t007 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 11 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF Discussion To our knowledge, the current study is the first validation study of the FSCRS-SF for the Span- ish population and the second that validates it after the original work of Sommers-Spijkerman et al. [52]. Our main contribution was to test the FSCRS-SF as a stand-alone instrument for the first time, i.e., to directly administer the FSCRS as short form. Furthermore, it was assessed in a clinical sample composed of BPD and ED patients, for whom measurement and treatment of SC is essential. The aim was to examine the psychometric properties of the Spanish valida- tion of the short form of the FSCRS, to explore differences in SC and RS among the general population with different levels of meditation experience and clinical patients, to assess its use- fulness as an outcome measure after an MCBI, and to explore the mediator and predictive role of SC and RS on psychopathology symptoms. Its factorial structure, internal consistency, con- vergent, divergent, known-group, and predictive validity were examined. The three-dimensional factor structure provided a very good fit in the non-clinical sample. This result supports the previous findings of Sommers-Spijkerman et al. [52] regarding the three-factor solution and rationale of the cognitive-evolutionary model [68]. In addition, the three-dimensional model provides a better fit than the unidimensional and bifactorial ones according to the results of the confirmatory factor analyses of the FSCRS in clinical and non- clinical samples [44,45,48,69–71]. This is in contrast with a large intercultural study which has shown that a two-factor model of RS and SC (combining IS and HS) had a superior fit, although the three-factor one was acceptable too [46]. Then, following the parsimony principle in factor analysis, it seems that professionals should choose the simpler model. However, Gil- bert’s [23] theoretical understanding of SC has important implications for clinical practice, since it offers a more accurate description of SC manifestation in non-clinical and clinical sam- ples. So, to the extent that both factor structures are acceptable, researchers and clinicians should choose those most relevant to their context. Regarding reliability, internal consistency analyses showed the FSCRS-SF as a reliable self- report measure. Reliability coefficients are higher than those obtained in the Dutch version ([52]; α = .52-.72; ω = .49-.72) and these results are in line with previous studies of the long form [44,46]. Furthermore, the test-retest reliability was acceptable for IS and HS scores and questionable for RS scores, which means that these subscales are reasonably stable considering the three-month interval. It allows the assessment of the effectiveness of interventions aimed at reducing SC. As proof of this, participants who participated in the MCBI showed significant improvements in RS and a decrease in IS and HS levels. Along this line, the FSCRS has been able to detect SC and RS changes in a variety of interventions, such as compassion-based inter- ventions [e.g., 33,72] and mindfulness-based interventions [e.g., 34]. Our results indicate a clear relationship between SC facets and negative psychological health. These correlation patterns are consistent with previous findings regarding IS and HS factors, which have been associated with high levels of depression, anxiety, stress, pessimism, isolation, shame, eating-related difficulties, body mass index, and facial-emotion recognition difficulties [44,48,72–75]. Along these lines, RS has been associated with high levels of self- compassion [76], dispositional optimism [44], weight-related positive affect, and overall men- tal well-being [77]. Furthermore, BPD and ED patients showed significant higher SC and lower RS levels than non-clinical participants, thus indicating that the FSCRS-SF is able to dis- criminate between clinical groups that are known to differ in these two variables. A range of disorders, which include BPD and ED, are associated with high SC and low RS [69], though further studies are needed to describe mechanisms through which SC works in these patholo- gies [6]. In the case of BPD, SC and self-invalidation [78] are terms that, without having the exact same meaning, have huge overlap. Moreover, the roles of invalidation and self- PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 12 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF invalidation in the development of BPD have been already studied [79,80]. In this regard, Per- kins et al. [81] have recently described how SC predicts nonsuicidal self-injury behaviors at two months’ time in an ED sample. In addition, high SC has been associated with affective var- iability in BPD patients [82]. As mentioned previously, SC is sensitive to meditation training (e.g., WTCP [53]), in par- ticular to meditation-based interventions that foster compassion, which is the theoretically proposed change mechanism underlying the decreasing of SC [e.g., 23,37,83]. In this regard, a recent meta-analysis has shown that self-compassion interventions are effective for decreasing self-criticism [84]. For instance, Compassion-Focused Therapy (CFT) focus on cultivating feelings of safeness and reassurance toward oneself in order to reduce SC [23]. As well, the Mindful Self-Compassion (MSC; [83]) and Loving-Kindness Meditation (LKM; [37]) pro- grams teach people to be kinder and more compassionate toward themselves through medita- tion. However, not only interventions that explicitly teach compassion (e.g., CFT, MSC, and LKM) are effective to enhance it, but also mindfulness-based interventions, which teach com- passion implicitly (e.g., Mindfulness-based Stress Reduction program) are effective too [85,86]. Although the implicit teaching of self-compassion might have a lower impact on it [87]. In fact, meditation experience (time of regular practice) was associated with lower levels of repetitive negative thinking, a similar psychological process to SC, being this association mediated by both self-compassion and mindfulness [88]. However, differences in SC between active meditators and meditators who abandoned the practice have not been previously inves- tigated. We hypothesized that participants who usually meditate will show significant lower levels of IS and higher RS than both those who have meditation experience but did not practice during the last year and non-meditators. Our findings show that individuals who usually medi- tate and non-active meditators had no significantly different IS and RS levels. However, active meditators had significantly lower IS and higher RS levels than non-meditators. Interestingly, mediation analysis showed that both subsamples had less internal inadequacy by mistakes and more self-reassuring responses than participants without meditation experience, which in turn led them to feel less distress than non-meditators. Altogether, these results suggest that some mechanisms that could be learnt and developed through meditation [39] are temporally stable and may protect from SC, even for those who stopped meditating a year ago. Further studies should be designed to analyze this interesting result. In this line, Sommers-Spijkerman et al. [31] examined the potential mediator role of RS and IS in explaining the underlying mecha- nisms through Compassion-Focused Therapy (CFT). Their results showed that participants who received CFT intervention (compared to wait-list participants) had more RS and less IS after the intervention, in turn leading to more well-being. Our findings also show that RS was the only FSCRS-SF factor that made a significant pre- dictive contribution to distress at three months’ time. This result suggests that the ability to self-reassurance when things go wrong is better predicting psychopathology than SC. This sup- ports the idea that RS is an independent factor for self-defense against SC [e.g., 89], meaning that its presence (or lack) determines the effect of SC. In this regard, RS was found to be a buffer of IS on depressive symptomatology [30]. That is, IS was weakly associated to depressive symptoms in individuals with high RS while this relationship was stronger and significant for low-RS ones. Limitations and future research Regarding the present study, some limitations deserve to be addressed. First of all, the combi- nation of online and in-person recruitment might have biased the results. In addition, the design of the present study is mainly cross-sectional, so the causality suggested by the PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 13 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF mediation analysis should be complemented with future longitudinal studies. Third, partici- pants were classified in the levels of the independent variable ‘meditation experience’ accord- ing to brief reported information of their previous practice. Finally, sample size could be larger and subsamples more balanced to increase the power of the analysis and to conduct measure- ment invariance evaluation, although ours was above the minimum for the implemented psy- chometric techniques. Also connected to this issue, it is worth noting that the R squared change in the hierarchical multiple regression was small, although the predictive model includ- ing baseline distress and FSCRS-SF subscales was statistically significant. Likewise, future research could test measurement invariance of FSCRS-SF subscales across non-clinical and clinical samples. In addition, other Spanish-speaking countries should evalu- ate our Spanish language version taking into account expressions that may have a different meaning. Finally, interventions with control condition to treat SC should confirm the useful- ness of this short form to measure pre-post changes. Conclusions In summary, the Spanish version of the FSCRS-SF is a valid and reliable instrument to measure IS, HS, and RS in non-clinical samples. The findings also show that the FSCRS-SF subscales distinguish between clinical and non-clinical individuals and predict distress at three months’ time. Moreover, IS and RS mediate distress among individuals with different frequency of meditation practice and this short form is an adequate outcome instrument to detect changes after an MCBI. An implication for practice is thus offering the possibility to assess SC and RS with a short- ened version of the FSCRS with all psychometric guarantees, which is especially useful in the research context. Moreover, our results add information about the maintenance of the effects of meditation practice on people’s ability to reassure themselves and be less self-critical. This gives hints about the planning of follow-up sessions in the context of compassion-based inter- ventions, for instance. Supporting information S1 File. Spanish translation of the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short Form. (DOCX) Acknowledgments The authors are grateful to CIBEROBN, an initiative of the ISCIII (ISCIII CB06 03/0052). Author Contributions Conceptualization: Jaime Navarrete, Rosa Baños, Ausiàs Cebolla. Data curation: Jaime Navarrete, Joaquim Soler, Elisabet Domı́nguez-Clavé. Formal analysis: Jaime Navarrete. Investigation: Jaime Navarrete, Rosa Baños, Ausiàs Cebolla. Methodology: Jaime Navarrete, Ausiàs Cebolla. Project administration: Jaime Navarrete, Elisabet Domı́nguez-Clavé, Ausiàs Cebolla. Resources: Joaquim Soler, Elisabet Domı́nguez-Clavé, Ausiàs Cebolla. PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 14 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF Supervision: Rocı́o Herrero, Ausiàs Cebolla. Validation: Jaime Navarrete. Writing – original draft: Jaime Navarrete. Writing – review & editing: Jaime Navarrete, Rocı́o Herrero, Joaquim Soler, Elisabet Domı́n- guez-Clavé, Rosa Baños, Ausiàs Cebolla. References 1. Andersen P, Toner PT, Bland JM, McMillan D. Effectiveness of transdiagnostic cognitive behaviour therapy for anxiety and depression in adults: a systematic review and meta-analysis. Behavioural and cognitive psychotherapy. 2016;673–90. https://doi.org/10.1017/S1352465816000229 PMID: 27301967 2. Fusar-Poli P, Solmi M, Brondino N, Davies C, Chae C, Politi P, et al. Transdiagnostic psychiatry: a sys- tematic review. World Psychiatry. 2019; 18(2):192–207. https://doi.org/10.1002/wps.20631 PMID: 31059629 3. Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical psychology review. 2015; 40:91–110. https://doi.org/10.1016/j.cpr.2015.06.002 PMID: 26094079 4. Reinholt N, Krogh J. Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a sys- tematic review and meta-analysis of published outcome studies. Cognitive Behaviour Therapy. 2014; 43(3):171–84. https://doi.org/10.1080/16506073.2014.897367 PMID: 24646219 5. Barlow DH, Allen LB, Choate ML. Toward a Unified Treatment for Emotional Disorders—Republished Article. Behav Ther. noviembre de 2016; 47(6):838–53. https://doi.org/10.1016/j.beth.2016.11.005 PMID: 27993336 6. Werner AM, Tibubos AN, Rohrmann S, Reiss N. The clinical trait self-criticism and its relation to psycho- pathology: A systematic review–Update. Journal of Affective Disorders. 2019; 246:530–47. https://doi. org/10.1016/j.jad.2018.12.069 PMID: 30599378 7. Cox BJ, McWilliams LA, Enns MW, Clara IP. Broad and specific personality dimensions associated with major depression in a nationally representative sample. Comprehensive Psychiatry. 2004; 45(4):246– 53. https://doi.org/10.1016/j.comppsych.2004.03.002 PMID: 15224266 8. Dinger U, Barrett MS, Zimmermann J, Schauenburg H, Wright AG, Renner F, et al. Interpersonal prob- lems, dependency, and self-criticism in major depressive disorder. Journal of clinical psychology. 2015; 71(1):93–104. https://doi.org/10.1002/jclp.22120 PMID: 25283680 9. Ehret AM, Joormann J, Berking M. Examining risk and resilience factors for depression: The role of self- criticism and self-compassion. Cognition and Emotion. 2015; 29(8):1496–504. https://doi.org/10.1080/ 02699931.2014.992394 PMID: 25517734 10. Gilbert P, Baldwin MW, Irons C, Baccus JR, Palmer M. Self-criticism and self-warmth: An imagery study exploring their relation to depression. Journal of Cognitive Psychotherapy. 2006; 20(2):183–200. 11. Powers TA, Zuroff DC, Topciu RA. Covert and overt expressions of self-criticism and perfectionism and their relation to depression. European Journal of Personality. 2004; 18(1):61–72. 12. Iancu I, Bodner E, Ben-Zion IZ. Self esteem, dependency, self-efficacy and self-criticism in social anxi- ety disorder. Comprehensive psychiatry. 2015; 58:165–71. https://doi.org/10.1016/j.comppsych.2014. 11.018 PMID: 25556952 13. Shahar B, Doron G, Szepsenwol O. Childhood maltreatment, shame-proneness and self-criticism in social anxiety disorder: A sequential mediational model. Clinical psychology & psychotherapy. 2015; 22 (6):570–9. https://doi.org/10.1002/cpp.1918 PMID: 25196782 14. Kingston C, Schuurmans-Stekhoven J. Life hassles and delusional ideation: Scoping the potential role of cognitive and affective mediators. Psychology and Psychotherapy: Theory, Research and Practice. 2016; 89(4):445–63. https://doi.org/10.1111/papt.12089 PMID: 26846698 15. Fennig S, Hadas A, Itzhaky L, Roe D, Apter A, Shahar G. Self-criticism is a key predictor of eating disor- der dimensions among inpatient adolescent females. International Journal of Eating Disorders. 2008; 41(8):762–5. https://doi.org/10.1002/eat.20573 PMID: 18570191 16. Kelly AC, Carter JC. Why self-critical patients present with more severe eating disorder pathology: The mediating role of shame. British Journal of Clinical Psychology. 2013; 52(2):148–61. https://doi.org/10. 1111/bjc.12006 PMID: 24215145 17. Noordenbos G, Aliakbari N, Campbell R. The relationship among critical inner voices, low self-esteem, and self-criticism in eating disorders. Eating disorders. 2014; 22(4):337–51. https://doi.org/10.1080/ 10640266.2014.898983 PMID: 24678635 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 15 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF 18. Palmeira L, Pinto-Gouveia J, Cunha M, Carvalho S. Finding the link between internalized weight-stigma and binge eating behaviors in Portuguese adult women with overweight and obesity: The mediator role of self-criticism and self-reassurance. Eating behaviors. 2017; 26:50–4. https://doi.org/10.1016/j. eatbeh.2017.01.006 PMID: 28135620 19. Gilbert P, McEwan K, Irons C, Bhundia R, Christie R, Broomhead C, et al. Self-harm in a mixed clinical population: The roles of self-criticism, shame, and social rank. British Journal of Clinical Psychology. 2010; 49(4):563–76. 20. Falgares G, Marchetti D, De Santis S, Carrozzino D, Kopala-Sibley DC, Fulcheri M, et al. Attachment styles and suicide-related behaviors in adolescence: the mediating role of self-criticism and depen- dency. Frontiers in psychiatry. 2017; 8:36. https://doi.org/10.3389/fpsyt.2017.00036 PMID: 28344562 21. Smith DM, Wang SB, Carter ML, Fox KR, Hooley JM. Longitudinal predictors of self-injurious thoughts and behaviors in sexual and gender minority adolescents. Journal of abnormal psychology. 2020; 129 (1):114. https://doi.org/10.1037/abn0000483 PMID: 31657599 22. Löw CA, Schauenburg H, Dinger U. Self-criticism and psychotherapy outcome: A systematic review and meta-analysis. Clinical psychology review. 2020; 75:101808. https://doi.org/10.1016/j.cpr.2019. 101808 PMID: 31864153 23. Gilbert P. The origins and nature of compassion focused therapy. British Journal of Clinical Psychology. 2014; 53(1):6–41. https://doi.org/10.1111/bjc.12043 PMID: 24588760 24. Gilbert P, Clarke M, Hempel S, Miles JN, Irons C. Criticizing and reassuring oneself: An exploration of forms, styles and reasons in female students. British Journal of Clinical Psychology. 2004; 43(1):31–50. https://doi.org/10.1348/014466504772812959 PMID: 15005905 25. Hermanto N, Zuroff DC. The social mentality theory of self-compassion and self-reassurance: The inter- active effect of care-seeking and caregiving. The Journal of social psychology. 2016; 156(5):523–35. https://doi.org/10.1080/00224545.2015.1135779 PMID: 26736073 26. Kim JJ, Henderson T, Best T, Cunnington R, Kirby JN. Neural and Self-Report Markers of Reassur- ance: A Generalized Additive Modelling Approach. Frontiers in psychiatry. 2020; 11:1000. https://doi. org/10.3389/fpsyt.2020.566141 PMID: 33173515 27. Longe O, Maratos FA, Gilbert P, Evans G, Volker F, Rockliff H, et al. Having a word with yourself: Neural correlates of self-criticism and self-reassurance. NeuroImage. 15 de enero de 2010; 49(2):1849–56. https://doi.org/10.1016/j.neuroimage.2009.09.019 PMID: 19770047 28. Duarte C, Pinto-Gouveia J. Can Self-Reassurance Buffer against the Impact of Bullying? Effects on Body Shame and Disordered Eating in Adolescence. J Child Fam Stud. abril de 2017; 26(4):998–1006. 29. Mendes AL, Ferreira C, Trindade IA. The central role of self-reassurance to explain body and eating atti- tudes. Eat Weight Disord. 2019; 24(5):861–8. https://doi.org/10.1007/s40519-018-0568-0 PMID: 30168034 30. Petrocchi N, Dentale F, Gilbert P. Self-reassurance, not self-esteem, serves as a buffer between self- criticism and depressive symptoms. Psychology and Psychotherapy: Theory, Research and Practice. 2019; 92(3):394–406. 31. Sommers-Spijkerman M, Trompetter H, Schreurs K, Bohlmeijer E. Pathways to improving mental health in compassion-focused therapy: Self-reassurance, self-criticism and affect as mediators of change. Frontiers in psychology. 2018; 9: 2442. https://doi.org/10.3389/fpsyg.2018.02442 PMID: 30568617 32. Gilbert P, Irons C. Focused therapies and compassionate mind training for shame and self-attacking. In: Gilbert P, editor. Compassion: Conceptualisations, research and use in psychotherapy. New York, NY, US: Routledge; 2005. p. 263–325. 33. Feliu-Soler A, Pascual JC, Elices M, Martı́n-Blanco A, Carmona C, Cebolla A, et al. Fostering Self-Com- passion and Loving-Kindness in Patients With Borderline Personality Disorder: A Randomized Pilot Study. Clinical Psychology & Psychotherapy. 2017; 24(1):278–86. https://doi.org/10.1002/cpp.2000 PMID: 26818533 34. Halamova J, Kanovsky M, Jurkova V, Kupeli N. Effect of a Short-Term Online Version of a Mindfulness- Based Intervention on Self-criticism and Self-compassion in a Nonclinical Sample. Studia Psychologica. 2018; 60(4):259–73. 35. Krieger T, Reber F, von Glutz B, Urech A, Moser CT, Schulz A, et al. An Internet-Based Compassion- Focused Intervention for Increased Self-Criticism: A Randomized Controlled Trial. Behavior Therapy. 2019; 50(2):430–45. https://doi.org/10.1016/j.beth.2018.08.003 PMID: 30824257 36. Ondrejková N, Halamová J, Strnádelová B. Effect of the intervention mindfulness based compassionate living on the-level of self-criticism and self–compassion. Current Psychology. 2020;1–8. 37. Shahar B, Szepsenwol O, Zilcha-Mano S, Haim N, Zamir O, Levi-Yeshuvi S, et al. A Wait-List Random- ized Controlled Trial of Loving-Kindness Meditation Programme for Self-Criticism. Clinical Psychology & Psychotherapy. 2015; 22(4):346–56. https://doi.org/10.1002/cpp.1893 PMID: 24633992 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 16 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF 38. Dahl CJ, Lutz A, Davidson RJ. Reconstructing and deconstructing the self: cognitive mechanisms in meditation practice. Trends in Cognitive Sciences. 2015; 19(9):515–23. https://doi.org/10.1016/j.tics. 2015.07.001 PMID: 26231761 39. Cebolla A, Galiana L, Campos D, Oliver A, Soler J, Demarzo M, et al. How does mindfulness work? Exploring a theoretical model using samples of meditators and non-meditators. Mindfulness. 2018; 9 (3): 860–870. 40. Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspect Psychol Sci. 2011; 6(6):537–59. https://doi.org/10.1177/1745691611419671 PMID: 26168376 41. Hofmann SG, Grossman P, Hinton DE. Loving-kindness and compassion meditation: Potential for psy- chological interventions. Clinical Psychology Review. 2011; 31(7):1126–32. https://doi.org/10.1016/j. cpr.2011.07.003 PMID: 21840289 42. Rose AV, Rimes KA. Self-criticism self-report measures: Systematic review. Psychology and Psycho- therapy: Theory, Research and Practice. 2018; 91(4):450–89. https://doi.org/10.1111/papt.12171 PMID: 29345799 43. Smart LM, Peters JR, Baer RA. Development and Validation of a Measure of Self-Critical Rumination. Assessment. 2016; 23(3):321–32. https://doi.org/10.1177/1073191115573300 PMID: 25712674 44. Castilho P, Pinto-Gouveia J, Duarte J. Exploring Self-criticism: Confirmatory Factor Analysis of the FSCRS in Clinical and Nonclinical Samples. Clinical Psychology & Psychotherapy. 2015; 22(2):153– 64. https://doi.org/10.1002/cpp.1881 PMID: 24307461 45. Baião R, Gilbert P, McEwan K, Carvalho S. Forms of Self-Criticising/Attacking & Self-Reassuring Scale: Psychometric properties and normative study. Psychology and Psychotherapy: Theory, Research and Practice. 2015; 88(4):438–52. 46. Halamová J, Kanovský M, Gilbert P, Troop NA, Zuroff DC, Hermanto N, et al. The Factor Structure of the Forms of Self-Criticising/Attacking & Self-Reassuring Scale in Thirteen Distinct Populations. J Psy- chopathol Behav Assess. 2018; 40(4):736–51. https://doi.org/10.1007/s10862-018-9686-2 PMID: 30459486 47. Halamová J, Kanovský M, Gilbert P, Troop NA, Zuroff DC, Petrocchi N, et al. Multiple Group IRT Mea- surement Invariance Analysis of the Forms of Self-Criticising/Attacking and Self-Reassuring Scale in Thirteen International Samples. J Rat-Emo Cognitive-Behav Ther. 2019; 37(4):411–44. 48. Leboeuf I, Mahanga J, Rusinek S, Delamillieure P, Gheysen F, Andreotti E, et al. Validation of the French version of the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale. Stress and Health. 2020; 36(1):31–6. https://doi.org/10.1002/smi.2909 PMID: 31714019 49. Donald F, Lawrence KA, Broadbear JH, Rao S. An exploration of self-compassion and self-criticism in the context of personal recovery from borderline personality disorder. Australas Psychiatry. 2019; 27 (1):56–9. https://doi.org/10.1177/1039856218797418 PMID: 30226078 50. Duarte C, Ferreira C, Pinto-Gouveia J. At the core of eating disorders: Overvaluation, social rank, self- criticism and shame in anorexia, bulimia and binge eating disorder. Comprehensive Psychiatry. 2016; 66:123–31. https://doi.org/10.1016/j.comppsych.2016.01.003 PMID: 26995245 51. Thew GR, Gregory JD, Roberts K, Rimes KA. The phenomenology of self-critical thinking in people with depression, eating disorders, and in healthy individuals. Psychology and Psychotherapy: Theory, Research and Practice. 2017; 90(4):751–69. 52. Sommers-Spijkerman M, Trompetter H, ten Klooster P, Schreurs K, Gilbert P, Bohlmeijer E. Develop- ment and validation of the forms of Self-Criticizing/Attacking and Self-Reassuring Scale—Short Form. Psychological Assessment. 2018; 30(6):729–43. https://doi.org/10.1037/pas0000514 PMID: 28795825 53. Cebolla A, Herrero R, Carrillo A, Navarro J, Soler J, Alvear D. Contemplative Practice-Based Well- Being Training (CBWT): Towards a Contemplative Positive Psychology. In Galiana L, Sansó N, editors. The power of compassion. New York: Nova Science Publishers; 2019. pp. 159–174. 54. Davidson RJ, Schuyler BS. Neuroscience of happiness. World Happiness Report. 2015;88–105. 55. Raes F, Pommier E, Neff KD, Gucht DV. Construction and factorial validation of a short form of the Self- Compassion Scale. Clinical Psychology & Psychotherapy. 2011; 18(3):250–5. 56. Garcia-Campayo J, Navarro-Gil M, Andrés E, Montero-Marin J, López-Artal L, Demarzo MMP. Valida- tion of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS). Health and Quality of Life Outcomes. 2014; 12(1):4. 57. López A, Sanderman R, Smink A, Zhang Y, Sonderen E van, Ranchor A, et al. A Reconsideration of the Self-Compassion Scale’s Total Score: Self-Compassion versus Self-Criticism. PLOS ONE. 2015; 10 (7). https://doi.org/10.1371/journal.pone.0132940 PMID: 26193654 58. Muris P, Otgaar H. The Process of Science: A Critical Evaluation of more than 15 Years of Research on Self-Compassion with the Self-Compassion Scale. Mindfulness. 2020; 11(6):1469–82. PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 17 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF 59. Derogatis LR. The Brief Symptom Inventory-18 (BSI-18): Administration. Scoring, and Procedures Manual ( 3rd ed.), Minneapolis: National Computer Systems; 2000. 60. Galdón MJ, Durá E, Andreu Y, Ferrando M, Murgui S, Pérez S, et al. Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer sample. Journal of Psychosomatic Research. 2008; 65(6):533–9. https://doi.org/10.1016/j.jpsychores.2008.05.009 PMID: 19027441 61. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999; 6(1):1–55. 62. Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis ( 7th ed.). Hampshire, UK: Cen- gage Learning; 2019. 63. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951; 16(3):297– 334. 64. McDonald RP. Test Theory: A Unified Treatment. Psychology Press; 2013. 65. Gignac GE, Szodorai ET. Effect size guidelines for individual differences researchers. Personality and Individual Differences. 2016; 102:74–8. 66. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, N.J: L. Erlbaum Associates; 1988. 67. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis, Second Edition: A Regression-Based Approach. Guilford Publications; 2017. 68. Gilbert P. Human Nature and Suffering. Routledge; 2016. 69. Biermann M, Bohus M, Gilbert P, Vonderlin R, Cornelisse S, Osen B, et al. Psychometric properties of the German version of the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS). Psychological Assessment. 2021; 33(1):97–110. https://doi.org/10.1037/pas0000956 PMID: 32986453 70. Halamová J, Kanovský M, Pacúchová M. Robust psychometric analysis and factor structure of the Forms of Self–criticizing/Attacking and Self–Reassuring Scale. Československá Psychologie: Časopis Pro Psychologickou Teorii a Praxi. 2017; 61(4):331–49. 71. Kupeli N, Chilcot J, Schmidt UH, Campbell IC, Troop NA. A confirmatory factor analysis and validation of the forms of self-criticism/reassurance scale. British Journal of Clinical Psychology. 2013; 52(1):12– 25. https://doi.org/10.1111/j.2044-8260.2012.02042.x PMID: 23398109 72. Duarte C, Stubbs JR, Gilbert P, Stalker C, Catarino F, Basran J, et al. The Weight-Focused Forms of Self-Criticising/Attacking and Self-Reassuring Scale: Confirmatory Factor Analysis and associations with control, loss of control of eating and weight in overweight and obese women. Psychology and Psy- chotherapy: Theory, Research and Practice. 2019; 92(4):539–53. https://doi.org/10.1111/papt.12196 PMID: 30134018 73. Castilho P, Pinto-Gouveia J, Duarte J. Two forms of self-criticism mediate differently the shame– psychopathological symptoms link. Psychology and Psychotherapy: Theory, Research and Practice. 2017; 90(1):44–54. https://doi.org/10.1111/papt.12094 PMID: 27249062 74. Cunha M, Paiva MJ. Text Anxiety in Adolescents: The Role of Self-Criticism and Acceptance and Mind- fulness Skills. The Spanish Journal of Psychology. 2012; 15(2):533–43. https://doi.org/10.5209/rev_ sjop.2012.v15.n2.38864 PMID: 22774427 75. Strnádelová B, Halamová J, Kanovský M. Eye-tracking of Facial Emotions in Relation to Self-criticism and Self-reassurance. Applied Artificial Intelligence. 2019; 33(10):839–62. 76. Kotera Y, Sheffield D. Revisiting the Self-compassion Scale-Short Form: Stronger Associations with Self-inadequacy and Resilience. SN Compr Clin Med. 2020; 2(6):761–9. 77. Duarte C, Stubbs J, Pinto-Gouveia J, Matos M, Gale C, Morris L, et al. The Impact of Self-Criticism and Self-Reassurance on Weight-Related Affect and Well-Being in Participants of a Commercial Weight Management Programme. OFA. 2017; 10(2):65–75. https://doi.org/10.1159/000454834 PMID: 28376484 78. Linehan MM. Skills training manual for treating borderline personality disorder. New York, NY, US: Guilford Press; 1993. 79. Musser N, Zalewski M, Stepp S, Lewis J. A systematic review of negative parenting practices predicting borderline personality disorder: Are we measuring biosocial theory’s ‘invalidating environment’? Clinical Psychology Review. 2018; 65:1–16. https://doi.org/10.1016/j.cpr.2018.06.003 PMID: 30055510 80. Sauer SE, Baer RA. Validation of Measures of Biosocial Precursors to Borderline Personality Disorder: Childhood Emotional Vulnerability and Environmental Invalidation. Assessment. 2010; 17(4):454–66. https://doi.org/10.1177/1073191110373226 PMID: 20644079 81. Perkins NM, Ortiz SN, Smith AR. Self-criticism longitudinally predicts nonsuicidal self-injury in eating disorders. Eating Disorders. 2020; 28(2):157–70. https://doi.org/10.1080/10640266.2019.1695450 PMID: 31829807 PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 18 / 19 PLOS ONE Assessing self-criticism and self-reassurance with the Spanish version of the FSCRS-SF 82. Vansteelandt K, Houben M, Claes L, Berens A, Sleuwaegen E, Kuppens P. Self-criticism and depen- dency predict affective variability in borderline personality disorder: An ecological momentary assess- ment study. Personality Disorders: Theory, Research, and Treatment. 2020; 11(4):270–9. 83. Neff KD, Germer CK. A Pilot Study and Randomized Controlled Trial of the Mindful Self-Compassion Program. Journal of Clinical Psychology. 2013; 69(1):28–44. https://doi.org/10.1002/jclp.21923 PMID: 23070875 84. Ferrari M, Hunt C, Harrysunker A, Abbott MJ, Beath AP, Einstein DA. Self-Compassion Interventions and Psychosocial Outcomes: a Meta-Analysis of RCTs. Mindfulness. 2019; 10(8):1455–73. 85. Luberto CM, Shinday N, Song R, Philpotts LL, Park ER, Fricchione GL, et al. A Systematic Review and Meta-analysis of the Effects of Meditation on Empathy, Compassion, and Prosocial Behaviors. Mindful- ness. 2018; 9(3):708–24. https://doi.org/10.1007/s12671-017-0841-8 PMID: 30100929 86. Wasson RS, Barratt C, O’Brien WH. Effects of Mindfulness-Based Interventions on Self-compassion in Health Care Professionals: a Meta-analysis. Mindfulness. 2020; 11(8):1914–34. https://doi.org/10. 1007/s12671-020-01342-5 PMID: 32421083 87. Brito-Pons G, Campos D, Cebolla A. Implicit or Explicit Compassion? Effects of Compassion Cultivation Training and Comparison with Mindfulness-based Stress Reduction. Mindfulness. 2018; 9(5):1494– 508. 88. Schlosser M, Jones R, Demnitz-King H, Marchant NL. Meditation experience is associated with lower levels of repetitive negative thinking: The key role of self-compassion. Curr Psychol. 2020:1–12 89. Gilbert P, Durrant R, McEwan K. Investigating relationships between perfectionism, forms and functions of self-criticism, and sensitivity to put-down. Personality and Individual Differences. 2006; 41(7):1299– 308. PLOS ONE | https://doi.org/10.1371/journal.pone.0252089 May 24, 2021 19 / 19