High Levels Of Self-criticism Research Articles

A meta-analysis of disordered eating and its association with self-criticism and self-compassion.

Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE. Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted. Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88). Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE. Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments.

Understanding sport anxiety among competitive athletes: the role of shame, fear of self-compassion and self-criticism

ABSTRACT Self-compassion interventions have shown positive results in sporting contexts (e.g., lower levels of shame, self-criticism, and sport anxiety), yet athletes seem to be particularly resistant to embracing this attitude. The current study aimed to explore the association between athletes’ shame and anxiety through fear of self-compassion and self-criticism. Further, this study sought to explore differences in the mentioned variables regarding athletes’ sex and competitive level. A self-report questionnaire was conducted including athletes’ versions of the scales to assess shame, fear of self-compassion, self-criticism, and sport anxiety. The sample comprised of 258 Portuguese adult athletes (53.3% females; 47.7% males), with a mean age of 21.65 (SD = 3.49), currently competing in different sports and at varying levels. Results suggested that, when compared to males, female athletes presented higher levels of sport-specific shame, self-criticism, and anxiety, but no significant differences were found in fear of self-compassion. Also, no significant differences in the study variables were found regarding competitive level. A path analysis showed that, when controlling for the effect of age and years of practice, athletes’ shame had a direct effect on sport anxiety severity, and an indirect effect through increased fear of self-compassion and higher levels of self-criticism. Results confirmed the plausibility of the tested model, which accounted for 48% of sport anxiety’s variance. The results highlighted the importance of further understanding the role of fear of self-compassion on athletes’ mental health, as well as differences between male and female athletes in competitive sport settings.

A single-session VR intervention addressing self-compassion and self-criticism with and without perspective change: Results of a randomized controlled experiment

Excessive self-criticism is an important transdiagnostic psychological factor. In contrast, self-compassion can contribute to the resilience and recovery of clinical populations, making this an important target for treatment. Virtual Reality (VR) has the potential to improve existing interventions as it allows for personalized roleplays that can be experienced from different perspectives, by using the novel VR technique of perspective change. We investigated the effects of a VR intervention on self-criticism and self-compassion, and the added value of changing perspectives. In total, 68 undergraduate students with high levels of self-criticism were randomized to either the perspective change condition or the control condition. Participants played two roleplays in which they had to react compassionately toward a virtual character that expressed the participants' own self-critical thoughts. In the perspective change condition, after each roleplay perspective change was used to receive one's own compassionate words. Results showed that self-compassion increased and self-criticism decreased significantly in both conditions. No significant differences were found for negative and positive affect. Furthermore, no differences were found between the conditions. Thus, receiving compassionate words through perspective change had no additional effect. Expressing compassion to someone with similar self-criticism showed to be sufficient to reduce self-criticism and increase self-compassion.

Psychological Treatment Targeting Acceptance and Compassion in Chronic Pain Patients: A Randomized Controlled, Internet Delivered, Treatment Trial.

Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing acceptance and commitment therapy (ACT) and compassion focused therapy (CFT), could improve psychological wellbeing and disability in chronic pain patients with high levels of self-criticism in comparison to a wait-list control group. Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory and Perseverative Thinking Questionnaire. Missing data at post-intervention was 22.5%. Intention to treat (ITT) analyses were conducted using linear mixed-models. Results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large and these results were maintained at six-month follow-up. Rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favour for the treatment group. Internet-based ACT with CFT components shows promise as a viable treatment option in the management of chronic pain.

Development of self-critical abilities and values in students using digital games-based learning.

Young people are the driving force of society. Therefore, the well-being of society itself depends on what values and ideals they carry into adulthood. The purpose of this study was to identify and describe the values of contemporary Chinese youth in the context of their future life goals and to analyze how self-criticism shapes students' depressive tendencies with the use of digital games. This study was conducted at Shaanxi Technical College of Finance and Economics with 157 Chinese students between the ages of 18 and 25. One hundred nine girls and forty-eight boys were randomly selected for the study. The study was conducted in a Chinese cultural context using the method of experiment with a survey, statistical, and correlational data analysis. Correlation analysis showed that the correlation between self-criticism and N/NE is strong (rs ¼ 0.50-0.65), but it was most related to the positive emotional component of E/PE. Thus, no obvious and serious reasons for the development of depression in young people were found. The results showed that digital games cannot influence the development of self-critical abilities of students, however, they can be a high-quality tool in psychological work with students to determine depressive moods, an overestimated level of self-criticism, and other problems that prevent them from learning. This article has implications for further research in education, as it may provide a basis for developing and improving new methods of constructing curricula. They can be aimed at defining special attention to the psychological state of students to prevent depressive states caused by high levels of self-criticism.

The longitudinal contribution of prolonged grief to depression and suicide risk in the aftermath of suicide loss: The moderating role of self-criticism

BackgroundSuicide-loss survivors (SLSs)-individuals who lost family member to suicide, have been recognized as at risk for several mental health complications, including depression and suicide. Recent studies have emphasized the contribution of prolonged grief (PG) symptoms and suicide-related shame as facilitators of depression and suicide risk in the aftermath of suicide loss. In this six-year longitudinal design study, we examined self-criticism as a moderator of the link between PG and depression and suicide risk, with suicide-related shame mediating these links. MethodParticipants were 152 SLSs (130 females) aged 18–70 who completed questionnaires assessing prolonged grief, depression, and suicide risk as well as trauma-related shame and self-criticism. ResultsA moderated mediation model shows that high self-criticism intensified the relations between PG and shame and between shame and depression and suicide risk, above and beyond the contribution of the longitudinal PG trajectory. Importantly, the indirect effects of PG on both depression and suicide risk via shame levels were found only among SLSs with high levels of self-criticism. ConclusionThe findings highlight the critical longitudinal role of self-criticism in facilitating depression and suicide risk among SLSs with higher levels of PG. Theoretical implications relating to healing processes and focused clinical recommendations are discussed, including interventions for addressing self-criticism and suicide-related shame in the aftermath of suicide loss.

Moral injury, PTSD, and complex PTSD among Israeli health and social care workers during the COVID-19 pandemic: The moderating role of self-criticism.

During the COVID-19 pandemic, health and social care workers (HSCWs) are facing morally challenging situations and life-threatening decisions. Following exposure to potentially morally injurious events (PMIEs) that undermine deeply held moral beliefs and expectations, HSCWs might experience moral injury (MI) and other deleterious psychiatric consequences. The present study examined associations between exposure to PMIEs, MI symptoms, posttraumatic stress disorder (PTSD), complex PTSD (CPTSD), and self-criticism among HSCWs. A sample of 296 Israeli HSCWs responded to online validated self-report questionnaires in a cross-sectional designed survey in February and March 2021. Participants' self-reported PTSD (8.9%) and CPTSD (4.8%) rates match the rates of Israel's general population. A moderated-mediation model shows that high self-criticism intensified the relations between exposure to PMIEs and MI symptoms, and between MI symptoms and CPTSD symptoms. Importantly, the indirect effect of exposure to PMIEs on both PTSD and CPTSD symptoms via MI symptoms existed only among those with high levels of self-criticism. The study's findings offer a novel overview of the associations between patterns of exposure to PMIEs, MI, PTSD, and CPTSD. Clinicians treating HSCWs coping with COVID-19-related moral injury should be aware of the importance of high self-criticism in the possible posttraumatic sequelae of exposure to PMIEs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The complex relationships between dependency and self-criticism and suicidal behavior and ideation in early adulthood

Earlier studies have shown that self-criticism is a robust correlate of suicidal behavior (SB) and suicidal ideation (SI). However, research results regarding the relationship between dependency and SB/SI are mixed. Several studies have also shown that depressive symptoms mediate the relationship between dependency and/or self-criticism and SB/SI. We propose here that: (i) self-criticism may be a moderator of the relationship between dependency and a prior history of SB and SI and recent SI; and (ii) depressive symptoms and borderline personality disorder (BPD) may mediate the relationship between dependency and self-criticism and SB/SI. Young adults (n = 240), aged 18–39 years, completed self-report measures. Self-criticism was a robust correlate of SB and SI in multivariable analyses. Dependency was positively related to SB and SI only at high levels of self-criticism. Moreover, all indirect relationships between dependency and self-criticism and SB and SI via BPD, and some via depressive symptoms, were significant. The results indicate that self-criticism is a robust risk factor for SB/SI in early adulthood. Dependency may be a risk factor, but only at high levels of self-criticism, and/or when dependency-related BPD and/or depressive symptoms are present.

Does Compassion-Focused Therapy-Based Online Intervention Work for Chinese International Students With High Self-Criticism? A Randomized Controlled Trail

Self-criticism represents a central phenomenon among a variety of psychological distress and has been shown to relate to the motivational systems of competing and social ranking. The purpose of our study was to test the effect of online compassion-focused therapy (CFT)-based intervention (CFI) on Chinese international students in South Korea suffering from high self-criticism and related psychological distress. Thirty-two Chinese international students with a high level of self-criticism were randomized to either a four-session CFI group, a four-session rational emotive behavior therapy (REBT)—based online self-help approach group, or a wait-list (WL) control group. The results suggest that the CFI group demonstrated significant improvements in self-criticism, compassion, depression, anxiety, and shame, and these were greater than those in the REBT and WL groups. Our work provides evidence that CFI offers a possible approach for reducing self-criticism and related psychological distress and increasing compassion level for young Chinese populations.

Compassion Focused Group Therapy for Adult Female Survivors of Childhood Sexual Abuse: a Preliminary Investigation

ObjectivesThe adverse effects of childhood sexual abuse (CSA) are often significant and enduring. It is therefore important to identify therapeutic interventions that can effectively minimize these effects. Compassion focused therapy (CFT) was originally developed for people with high levels of self-criticism and shame. It holds significant promise as an intervention for survivors of CSA, but has not yet been empirically tested. This study explored both the acceptability and preliminary efficacy of a CFT group intervention (CFT-SA) for adult female survivors of CSA.MethodsCFT-SA was developed and tested with adult female survivors of CSA, to determine if there was any change in outcome measure scores after participating in the 12-week intervention (n = 30) and at 3-month post-intervention follow-up (n = 25).ResultsLow attrition and high session attendance, in addition to positive participant feedback, suggested the program had high acceptability. Significant improvement was observed across all outcome variables from pre- to post-intervention (n = 30), which were maintained at follow-up (n = 25). Participants demonstrated increased self-compassion and self-reassurance, and reduced symptoms of post-traumatic stress, shame, and self-criticism, as well as fears of compassion, depression, anxiety, and stress, with medium to large effect sizes (d = .55 to 1.36). Across all measures, between 20 and 57% of participants demonstrated reliable change pre- to post-intervention, and 22 to 57% from pre-intervention to follow-up.ConclusionsThis study provides preliminary support for the acceptability and potential benefits of utilizing CFT-SA as an intervention for adult female survivors of CSA and offers recommendations for future research.Trial Registration.Australian New Zealand Clinical Trials Registry, ACTRN12616001041448.

The role of social comparison and type of feedback on self-criticism in people with high levels of depressive symptoms

This research explores the relation between social comparison and self-criticism on a group of participants with elevated rates of depressive symptoms. In addition, the study investigated whether the type of feedback could moderate the relation between social comparison and self-criticism. The sample included 36 psychology students in the first year (N = 28 women, M age = 24.6, SD = 4.66) with high depressive symptoms. Results show that higher rates of negative social comparison are correlated with higher levels of self-criticism. Participants that received negative feedback reported an increase level of self-criticism compared to those from positive feedback condition. The type of feedback moderated the relation between social comparison and self-criticism. Our findings are discussed from the perspective of their practical implications for young adults experiencing high levels of depressive symptoms.

Can compassion-focused imagery be used as an attention bias modification treatment?

Compassion focused-imagery (CFI), one of the psychological interventions of compassion-focused therapy, is receiving increasing attention. It is a therapeutic tool that targets the process of self-criticism by prompting individuals to imagine themselves as compassionate or to imagine receiving compassion from an ideal compassionate other. This research examines the role of self-criticism in the attentional processing of emotional stimuli, namely, critical and compassionate facial expressions. It is hypothesized that the activation of positive social emotions through CFI plays a role in broadening attention in the processing of emotional stimuli. The McEwan Faces stimulus set, which includes critical, neutral and compassionate faces, was used to create an attentional bias task called the dot probe task. The processing of emotional faces was assessed before and after exposure to either CFI or neutral imagery, controlling for the process of sensory integration (n = 80). A between-subject analysis was used to test the hypothesis. Before the imagery task, participants tended to look away from critical faces, and their level of self-criticism played a role. Both types of imagery significantly reduced the bias away from critical faces when the stimuli were presented for 1200 ms. This effect was reversed in the neutral condition for participants with high levels of self-criticism but not in the CFI condition. Interestingly, self-criticism impacts the attentional treatment of critical faces and the effect of imagery entailing sensory integration on this treatment. CFI seems to preserve this effect for participants with high levels of self-criticism, possibly due to the activation of positive social emotions.

Moral injury and mental health outcomes among Israeli health and social care workers during the COVID-19 pandemic: a latent class analysis approach

ABSTRACT Background: The COVID-19 pandemic poses unique challenges to health and social care workers (HSCWs) who face morally challenging and life-threatening decisions. Following exposure to events that transgress moral beliefs and expectations, HSCWs might experience psychological, social, and spiritual problems referred to as Moral Injury (MI). Objective: The objectives of this study were to examine patterns of exposure to potentially morally injurious events (PMIEs) among HSCWs and their associations with MI, mental health outcomes and psychological correlates. Method: A sample of 296 Israeli HSCWs volunteered to complete a cross-sectional electronic survey with validated self-report questionnaires in February and March 2021. Latent Class Analysis (LCA) was used to identify classes characterized by unique patterns of exposure to PMIEs. Socio-demographic, work and COVID-related variables were used to predict patterns of exposure to PMIEs, and differences in mental-health outcomes and psychological correlates between classes were assessed. Results: Three subgroups were identified: ‘high exposure’ (19.5%), ‘betrayal-only’ (31.3%), and ‘minimal exposure’ (49.4%). Perceived stress increases the odds for inclusion in the ‘high exposure’ and ‘betrayal-only’ classes. Participants in both the High Exposure class and the betrayal-only classes reported higher levels of depressive, anxiety, posttraumatic and more moral injury symptoms as compared to the ‘minimal exposure’ class. Importantly, both ‘high exposure’ and ‘betrayal-only’ classes reported lower levels of self-compassion and higher levels of self-criticism, relative to those in the ‘minimal exposure’ class. Conclusions: The study’s findings offer an overview of the complex associations between patterns of exposure to PMIEs and associated predictors and outcomes. Clinicians treating HSCWs coping with COVID-19 related stress should be aware of the contribution of exposure to PMIEs to HSCWs’ distress and to the unique constellation of high self-criticism and low self-compassion among HSCWs with exposure to PMIEs.

Differences in Electromyography during Self-Compassionate and Self-Critical Imageries According to the Level of Self-Criticism

The aim of this study was to analyze changes in muscle activity between high and low self-critical participants during the imagery of self-compassion, self-protection, and self-criticism. Muscle activity was measured by the Biopac MP36 while participants were listening to the imagery audio recording. Levels of self-criticism were measured by The Forms of Self-Criticising/Attacking and Self-Reassuring Scale (FSCRS; Gilbert et al., 2004). From overall number of 110 participants, 30 participants were selected for further analysis based on their extreme level of self-criticism. The research sample consisted of 15 participants with high level of self-criticism and 15 with low level of self-criticism. The results showed that participants with higher levels of self-criticism had similar levels of muscle activity during the self-critical and self-protective phases of imagery. However, during the last self-compassionate imagery, participants with lower self-criticism returned to the baseline EMG levels, while those with higher self-criticism remained at high EMG levels. The results showed lower muscle activity in low self-critics while imagining inner compassionate part meaning. Therefore, low self-critics are probably better able to calm themselves down compared to high self-critics.

Psychological and Physiological Effects of the Mindful Lovingkindness Compassion Program on Highly Self-Critical University Students in South Korea.

ObjectivesSelf-critical behavior is especially relevant for university students who face academic and non-academic stressors, leading to negative outcomes such as mental distress and psychopathologies. To address this behavior, mindfulness and compassion are important factors to decrease self-criticism and ensure positive outcomes. This study examined the psychological and physiological effects of an intervention, the Mindful Lovingkindness Compassion Program (MLCP), on highly self-critical university students in South Korea.MethodsThirty-eight university students with a high level of self-criticism were assigned to an MLCP group (n = 18) or waitlist (WL) group (n = 20). Self-report measures of self-criticism, self-reassurance, psychological distress, and other mental health variables were completed, and the physiological measure of heart rate variability (HRV) was conducted before and after the intervention with both groups. In addition, 1- and 3-month follow-up assessments were conducted using self-report measurements.ResultsCompared to the WL group, participants in the MLCP group experienced significantly greater reductions in self-criticism and psychological distress, and a greater increase in self-reassurance, mental health, and HRV. The improvements in the self-report measures were maintained when assessed 1 and 3 months later.ConclusionsMLCP could be a promising intervention for alleviating self-criticism and increasing self-reassurance among self-critical individuals.

New Developments in Emotion-Focused Therapy for Social Anxiety Disorder.

Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-focused therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning, but through the activation of other, more adaptive emotions. EFT aims to access shame-based emotional memories that underlie SAD, and transform them by exposing them to new adaptive emotional experiences, such as empowering assertive anger, grief, and self-compassion. In this paper, the core features of EFT for SAD are presented, as well as the EFT view of dysfunction in SAD and EFT change processes. Research findings regarding the effectiveness of EFT for SAD are presented together with initial findings regarding mechanisms of change occurring during treatment.

Compassion-focused therapy groups for people with intellectual disabilities: An extended pilot study.

People with intellectual disabilities who experience mental health difficulties often have high levels of self-criticism and shame. Compassion-focused therapy is a therapeutic modality effective in working with such feelings. This article follows on from a previous compassion-focused therapy group study exploring the impact of two compassion-focused therapy-based groups on how participants felt about themselves. Utilizing a mixed method design, the study illustrated that participants experienced higher levels of compassion and, overall, saw themselves more favourably by the end of the groups. They were also able to understand the basic concepts of compassion-focused therapy which reinforced previous study findings, suggesting that it is adaptable and clinically useful for people with intellectual disabilities.

Heart Rate Variability Differences among Participants with Different Levels of Self-Criticism during Exposure to a Guided Imagery

Our goal was to investigate the heart rate variability differences among participants with different levels of self-criticism during exposure to self-critical, self-protective, and self-compassionate guided imagery. Convenience sample of 89 psychology students was collected with the provision of course credits. The participants underwent measurement of heart rate variability during the guided imagery and completed the Forms of Self-Criticising/Attacking and Self-Reassuring Scale to size their level of self-criticism. There were significant heart rate variability differences among participants with low and high levels of self-criticism in all relaxation baseline and three parts of the imagery. High self-critical participants were more distressed during the whole imagery compared to participants with low level of self-criticism. In addition, there was overall significant difference between all three imageries. Not surprisingly, the highest heart rate variability was found during the imagery self-compassionate part as we had expected. The level of self-criticism plays important role in the adjustment of physiological responses to distress. The findings brought a little light into possible diagnostics of high and low self-critical people on the basis of physiological measures without relying only on self-rating scales in future.

DSM-5 Assessments of the Level of Personality Functioning: Intrapersonal and Interpersonal Functioning

Objective: In DSM-5, Section III, the Level of Personality Functioning (LPF) was proposed as a severity index of personality disorders (PDs), but as it reflects both trait-like (availability) and state-like (accessibility) features, of which, moreover, the relationship with the experience of patients is unclear, we critically examined LPF in patients with general psychopathology. Method: This study compared the validity of the direct Inventory of Personality Organization (IPO), and the indirect Differentiation-Relatedness Scale (DRS) LPF-measure, in relation to measures of intrapersonal and interpersonal functioning. The sample consisted of 70 inpatients with general psychopathology and no primary PDs. Associations of both measures with DSM-PDs were examined, with and without controlling for clinical distress. Results: The IPO was significantly related to age and clinical distress. When controlling for clinical distress, the IPO was still associated with cluster A (odd) and B (erratic) PD features, high levels of self-criticism, conflict in relationships and low levels of adaptive coping strategies. The DRS was only related to the schizotypical PD. Conclusions: In patients with general psychopathology, both the IPO and the DRS, appear to have limitations in measuring LPF. The IPO seems to be prone to state effects, although correlations with PDs remained significant when controlling for clinical distress. The DRS seemed to be more independent from clinical distress but was unexpectedly unrelated to features of personality pathology. DRS reflects availability, while IPO also reflects different degrees of accessibility of LPF in PDs.

Personality Trait Predictive Utility and Stability in Transcranial Magnetic Stimulation (rTMS) for Major Depression: Dissociation of Neuroticism and Self-Criticism: Utilité prédictive et stabilité des traits de personnalité dans la stimulation magnétique transcrânienne répétitive (SMTr) pour la dépression majeure : dissociation du neuroticisme et de l’autocritique

Cost-efficient and non-invasive predictors of antidepressant response to repetitive transcranial magnetic stimulation (rTMS) are required. The personality vulnerabilities-neuroticism and self-criticism-are associated with antidepressant outcomes in other modalities; however, self-criticism has not been examined in response to rTMS, and the literature on neuroticism and rTMS is inconsistent. This naturalistic, 4-week study involved daily dorsolateral prefrontal cortex (DLFPC) rTMS for major depression (15 unipolar, 2 bipolar). Participants completed the Big Five Inventory (neuroticism) and the Depressive Experiences Questionnaire (self-criticism) at baseline and at the end of treatment. Changes in depressive symptoms, as rated by the clinician, were quantified using the 21-item Hamilton Depression Rating Scale. Given the inconsistencies in data regarding the stability of neuroticism in patients receiving rTMS, we performed a systematic review and quantitative meta-analysis of trials examining rTMS and neuroticism. rTMS significantly improved depressive symptoms, and this was predicted by higher levels of self-criticism but not neuroticism. Self-criticism was stable over the 4 weeks of rTMS; however, neuroticism decreased, and this was not related to decreases in depressive symptoms. Our quantitative meta-analysis of 4 rTMS trials in major depression ( n = 52 patients) revealed decreases in neuroticism, with a moderate effect size. Our results are limited by a small sample size, and the absence of a sham-rTMS group. Our meta-analysis included only 4 trials. Highly self-critical patients appear to benefit more from rTMS than less self-critical patients. Neuroticism, a conceptually similar but distinct personality domain, does not appear to predict antidepressant response, yet this vulnerability factor for depression decreases after rTMS.