Mindfulness (2017) 8:595–602
DOI 10.1007/s12671-016-0635-4
ORIGINAL PAPER
The Differential Moderating Roles of Self-Compassion
and Mindfulness in Self-Stigma and Well-Being Among People
Living with Mental Illness or HIV
Xue Yang 1 & Winnie W. S. Mak 2
Published online: 12 November 2016
# Springer Science+Business Media New York 2016
Abstract In addition to endorsing the content of stigmatizing
thoughts (self-stigma Bcontent^), how frequently and auto-
matically individuals think about these thoughts (self-stigma
Bprocess^) also have implications for their well-being. The
present study examined the roles of self-compassion and
mindfulness in moderating the relationships of self-stigma
content and process with subjective well-being of people in
recovery of mental illness (PMI) and people living with HIV
(PLHIV). Participants included 169 PMI and 291 PLHIV in
Hong Kong who reported their levels of self-compassion,
mindfulness, self-stigma content and process, and life satis-
faction. Path analyses indicated that the proposed model fitted
the two samples well, χ 2 (10) = 19, p = .04, CFI = .98,
NNFI = .93, and RMSEA = .04. In both groups, self-
compassion and mindfulness were significantly associated
with life satisfaction. Self-compassion moderated the relation-
ship between self-stigma content and life satisfaction among
PLHIV, while mindfulness moderated the relationship be-
tween self-stigma process and life satisfaction among PMI.
The differential moderating roles of self-compassion and
mindfulness in buffering the effects of self-stigma content
and process among PMI and PLHIV were identified, and im-
plications for stigma reduction and well-being promotion in
different stigmatized groups were discussed.
* Winnie W. S. Mak
wwsmak@psy.cuhk.edu.hk
1
Centre for Health Behaviours Research, JC School of Public Health
and Primary Care, Faculty of Medicine, The Chinese University of
Hong Kong, Shatin, NT, Hong Kong
2
Department of Psychology, The Chinese University of Hong Kong,
Shatin, NT, Hong Kong
Keywords Self-compassion . Mindfulness . Self-stigma .
Mental habit . Life satisfaction . People with mental illness .
People living with HIV
Introduction
Highly stigmatized groups, such as people in recovery of men-
tal illness (PMI) and people living with HIV (PLHIV), may
internalize negative evaluations from the public and subse-
quently react with negative self-perceptions and social with-
drawal (Corrigan and Watson 2002; Mak et al. 2007a).
However, having self-stigmatizing thoughts (self-stigma
content) may only partially explain their well-being.
Considering how frequently and automatically they think about
these self-stigmatizing thoughts (self-stigma process) may fur-
ther contribute to the understanding of their well-being (Chan
and Mak 2016). Most studies have focused on the content of
self-stigma in isolation from the process in which individuals
frequently and automatically think about these self-stigmatizing
thoughts (Corrigan and Watson 2002; Corrigan et al. 2006).
The literature on self-stigma process is sparse and has only
included PMI samples (Chan and Mak 2015, 2016).
Mindfulness and self-compassion have been suggested to buff-
er against self-stigma and enhance well-being among people
with various negative experiences (e.g., Keng et al. 2011;
MacBeth and Gumley 2012) through conceptually different
mechanisms (Neff and Dahm 2014). However, empirically lit-
tle is known on the extent to which or the mechanism by which
they work on self-stigmatizing thoughts in affecting well-being.
Self-stigma content refers to the endorsement of the content
of negative stereotypes and evaluations towards the self
among people with stigmatized identities, and it is the focus
of most studies on self-stigma in the literature (e.g., Mak et al.
2007a, b; Ritsher et al. 2003; Yanos et al. 2008). Typical and
596
common contents of self-stigmatizing thoughts including self-
defeating perceptions of being a burden, having a tainted life,
and having inconvenience in daily life are shared by various
stigmatized groups including PMI and PLHIV (Corrigan et al.
2012; Mak et al. 2007a, b; Ritsher et al. 2003). It is the cog-
nitive component of self-stigma and has been shown to be
associated with low self-worth, self-esteem, and self-efficacy
(Corrigan et al. 2006; Phillips et al. 2002; Van Brakel 2006).
What is missing from this body of self-stigma literature is
the frequency and degree of automaticity in which individuals
think about these thoughts (Verplanken and Velsvik 2008).
The repetition and automaticity of self-stigmatizing thoughts
is referred to as self-stigma process (Chan and Mak 2016).
Specifically, the process includes two features: (1) the repeat-
ed occurrence of negative thoughts about the stigmatized iden-
tity and (2) the fact that such thoughts come automatically,
unconsciously, implicitly, and unintentionally. Frequent and
automatic self-stigmatizing thinkers often show a high level
of experiential avoidance and a lack of mindfulness in the face
of self-stigmatizing thoughts (Chan and Mak 2016). They
may be entangled in a metacognitive process that involves
undue negative evaluations of having such self-stigmatizing
thoughts, an unwillingness to accept such thoughts
(McCracken and Zhao-O’Brien 2010), and deliberate attempts
to eliminate, suppress, or avoid these thoughts (Hayes et al.
1999). Ironically, striving to control unwanted thoughts may
paradoxically elevate their frequency and accessibility
(Abramowitz et al. 2001; Gross 2002). This vicious circle
can lead to constant mental negotiations within individ-
uals, contributing to their experience of self-stigma and
chronic distress.
The cultivation of mindfulness could be an effective ap-
proach in curtailing the vicious circle in self-stigmatizing
thoughts (Chan and Mak 2016). Mindfulness entails being
aware of the present moment experience in a nonjudgmental
manner regardless of whether it is positive, negative, or neu-
tral (Brown and Ryan 2003; Kabat-Zinn 2003). In the face of
unwanted thoughts and experiences, mindful individuals tend
to be aware of their body sensations, thoughts, and emotions
with less reactivity and keep a stance of equanimity instead of
engaging in suppression or excessive fixation. By adding clar-
ity and vividness to the experience and by orienting to the
present moment with curiosity and openness, mindfulness
has shown to improve emotion regulation, distress tolerance,
and well-being (Bishop et al. 2004; Hofmann et al. 2010;
Ryan and Deci 2000). The nonjudgmental view of one’s
thoughts and the acceptance-based approach promoted by
mindfulness-based interventions can provide a metacognitive
insight into and acceptance of the illness and its symptoms,
alleviating the ruminative patterns of depressive episodes,
stress, and suicidal ideation for individuals with various men-
tal disorders, including anxiety, social phobia, depression, and
schizophrenia (Chadwick et al. 2009; Chien and Lee 2013;
Mindfulness (2017) 8:595–602
Davis et al. 2007; Teasdale et al. 2000), which is strongly
related with the development and relapse of mental disorders.
Mindfulness-based interventions have been suggested to Bbe
uniquely suited to impact distress related to symptoms and
internalized stigma that are particularly salient for individuals
living in the community with severe mental illness who are
susceptible to experiences of social rejection and interpersonal
stress^ (Davis and Kurzban 2012, p. 228).
According to Neff (2003), self-compassion involves posi-
tive self-perceptions as well as sensitivity to one’s own expe-
rience of suffering. It consists of three components including
self-kindness (versus self-judgment), common humanity (ver-
sus isolation), and mindfulness (versus over-identification).
Self-kindness has a soothing quality that offers oneself under-
standing and warmth instead of being coldly indifferent, self-
critical, or self-blaming in the face of inadequacy or failure.
Common humanity provides emotional safety by recognizing
one’s suffering does not occur in isolation, but is intimately
interconnected with others and inherent to the nature of life.
Finally, the mindfulness facet of self-compassion is similar to
the abovementioned notion of mindfulness but is narrower in
scope (Rapgay and Bystrisky 2009). It refers to maintaining a
balanced perspective in the midst of adversity and difficulties.
With self-compassion, positive emotions are generated by em-
bracing the negative ones, rather than replacing the negatives
with the positives (Germer and Neff 2013). Given its compre-
hensive multi-faceted nature, self-compassion has been found
to be associated with better well-being (e.g., life satisfaction,
psychological health, and happiness) and less maladaptive
perfectionism (Neff 2003; Neff et al. 2005, 2007). People with
depression and anxiety were found to have lower symptom
severity and higher quality of life when their self-compassion
is promoted (Van Dam et al. 2011).
Although both mindfulness and self-compassion may buff-
er negative self-judgment, turn towards painful experiences
with an accepting stance, and thereby enhance subjective
well-being (e.g., Keng et al. 2011; MacBeth and Gumley
2012), their distinctions and unique implications for human
functioning are worth noting. Mindfulness, as defined by most
contemporary literature, has an emphasis on metacognition,
that is, the ability to direct and sustain attention nonjudgmen-
tally, to observe our current and internal experience, and to be
Bexperientially open^ (Bishop et al. 2004). Therefore, it stands
in contrast to the mindless, less Bawake^ states of habitual or
automatic functioning that may be persistent for many indi-
viduals. Cultivating mindfulness is the key in disengaging
individuals from automatic thoughts, habits, and unhealthy
behavior patterns and in buffering the negative effect of rumi-
nation on well-being (Alleva et al. 2014; Hawley et al. 2014;
Ryan and Deci 2000; Verplanken 2012).
Self-compassion, on the other hand, focuses on cultivating
a positive attitude and state of mind in dealing particularly
with suffering (Germer 2009; Neff and Dahm 2014). In
Mindfulness (2017) 8:595–602
addition to not over-identifying with negative experiences,
self-compassionate persons also actively soothe and comfort
oneself when painful experiences arise and remember that
such experiences are part of being human. When the painful
experience involves thoughts of inadequacy (e.g., self-
stigmatizing judgments), extra mental effort may be needed
to curb self-criticism and to maintain a gentle kindness and
compassion towards the self (Neff 2003). For example, al-
though PLHIV might have applied the HIV-related critical
judgments and inadequacy about the self, by being self-com-
passionate, they are able to appreciate their imperfection that
is shared with other human beings and be mindfully aware of
their stigmatizing experiences, instead of denying themselves
as a whole, which mitigated the effect self-stigma content has
on their well-being.
The present study aimed to address the relationships of
self-stigma content and process with subjective well-being
and to identify the potential moderating roles of mindfulness
and self-compassion on these relationships in two highly stig-
matized groups. We hypothesized that self-stigma content and
process would be negatively related to subjective well-being.
In addition, mindfulness would be especially useful in weak-
ening the association between self-stigma process and subjec-
tive well-being, while self-compassion would be a powerful
buffer against the association between self-stigma content and
subjective well-being.
Method
Participants
Sample 1 consisted of 169 PMI (52.6% males) with an aver-
age age of 42.7 years (SD = 10.2). Most of them (68%,
n = 116) were single. Participants included people with
schizophrenia (67.2%, n = 114), depression (13.6%, n = 23),
bipolar disorder (11.2%, n = 19), or other mental disorders
(8%, n = 14). Most of them (97.6%, n = 165) reported using
psychotropic medication. Sample 2 consisted of 291 PLHIV
(94.8% men) with an average age of 41.8 years (SD = 11.1).
Most of them (67%, n = 195) were single. Around half of them
identified themselves as homosexual (48.3%, n = 140),
while the rest reported being bisexual (24.1%, n = 70) or
heterosexual (23.4%, n = 68). Over half of them reported that
their CD4 levels were lower than 500 cells/uL (55.2%,
n = 137), and 43.2% reported that their CD4 levels were
between 500 and 1000 cells/uL. Most of them (87.2%,
n = 254) were receiving anti-retroviral therapy.
Procedure
Ethics approval was obtained from the Clinical Research
Ethics Committee of the authors’ institution and the
597
Department of Health. PMI were recruited from four non-
governmental organizations (NGOs) in Hong Kong that pro-
vided community mental health services to people with men-
tal illness in Hong Kong. PLHIV were recruited at the only
community-based outpatient clinic specialized in treating
HIV-related illnesses in Hong Kong. The study was first in-
troduced to PMI by social workers at the service units or to
PLHIV by nurses at the outpatient clinic. For those individuals
who expressed initial interest, the staff referred them to our
trained research assistants, who explained the study purpose to
them for their informed consent. All participants were in-
formed that their decision to participate is unrelated to the
services received. Research assistants collected data when cli-
ents visited the organizations and were waiting for service. All
participants provided written informed consent prior to com-
pleting the battery of questionnaires. Upon completion of the
questionnaires, each participant was given HK$50
(∼US$6.45) as compensation for their time spent on the study.
Measures
Mindfulness
The tendency to be mindful in daily life was measured by the
validated Chinese version of the 20-item Five Facet
Mindfulness Questionnaire (FFMQ; Hou et al. 2014). It in-
cludes five dimensions: observing, describing, acting with
awareness, nonreactivity, and nonjudging. The participants
rated each item on a 5-point Likert scale, ranging from 1
(never) to 5 (always). Higher scores indicated higher levels
of mindfulness. In the present study, Cronbach’s alphas were
.75 in PLHIV and .90 in PMI.
Self-Compassion
The Chinese version of the Self-Compassion Scale-Short
Form (SCS-SF; Raes et al. 2011) was used to measure the
level of self-compassion. The 12 items were rated on a 5-
point Likert scale, ranging from 1 (never experience the
feeling) to 5 (experience the feeling continuously or almost
continuously). Higher scores indicated higher levels of self-
compassion. In the present study, Cronbach’s alphas were .70
in PLHIV and .82 in PMI.
Self-Stigma Content
The cognitive subscale of the Self-Stigma Scale (SSS; Mak
and Cheung 2010), which was originally developed in
Chinese and validated in Hong Kong, was used to measure
the degree of endorsement of self-stigmatizing cognitive con-
tent. Participants rated the extent to which they endorse each
item on a 6-point Likert scale from 1 (strongly disagree) to 6
(strongly agree). The target identity in the items was changed
598 Mindfulness (2017) 8:595–602

according to the participants. A sample item is BMy identity as Results

a person with mental illness/living with HIV is a burden to
me.^ Higher scores indicated greater endorsement of self-
stigma content. In the present study, Cronbach’s alphas of
the scale were .82 in PLHIV and .86 in PMI.
Self-Stigma Process
Five items in the Self-stigmatizing Thinking’s Automaticity
and Repetition Scale that was originally developed and vali-
dated among Chinese in Hong Kong (STARS; Chan and Mak
2016) were employed. Participants rated the extent to which
they endorse each item on a 6-point Likert scale from 1
(strongly disagree) to 5 (strongly agree). A sample item is
BThinking negatively about my MI/HIV identity is something
I do every day.^ Higher scores indicated more frequent and
automatic self-stigmatizing thoughts. Cronbach’s alphas were
.80 in PLHIV and .89 in PMI.
Life Satisfaction
The 5-item Chinese version of the Satisfaction with Life Scale
(Diener et al. 1985; Wu and Yao 2006) was used to measure
subjective well-being. Items are rated on a 7-point Likert scale
(1 = strongly disagree to 7 = strongly agree), with higher
scores indicating high life satisfaction. Cronbach’s alphas
were .88 in PLHIV and .89 in PMI.
Data Analyses
Independent t tests were conducted by SPSS 22.0 to identify
the group difference in the means of variables. Path analyses
and multi-sample path analyses were conducted by AMOS 19
to test the proposed model, moderation effects, and whether
the two groups shared the same model structure. All tests were
two-tailed with a significance level of p < .05.
Significant differences in the means of variables between the
two samples were found (see Table 1). Compared to PMI,
PLHIV were significantly higher on their levels of mindful-
ness, self-compassion, self-stigma content, and self-stigma
process (ps < .01). Life satisfaction was not significantly dif-
ferent between the two samples. In both samples, all variables
had significant correlations with each other (see Table 1).
Mindfulness and self-compassion were positively associated
with life satisfaction, while self-stigma content and process
were negatively associated with life satisfaction (ps < .05).
Path analyses showed that the proposed model (Fig. 1)
fitted the data in each group well, χ2(5) = 10.55, p = .06,
CFI = .98, NNFI = .93, and RMSEA = .06 in PLHIV and
χ 2 ( 5 ) = 8 . 4 5 , p = . 0 4 , C F I = . 9 8 , N N F I = . 9 3, a n d
RMSEA = .06 in PMI. Multi-sample path analysis showed
that PLHIV and PMI in the present study shared the same
model structure (Hu and Bentler 1999; Satorra and Bentler
2001), χ2(10) = 19.00, p = .04, CFI = .98, NNFI = .93, and
RMSEA = .04.
For PLHIV, self-compassion (β = .27, p < .001), mindful-
ness (β = .20, p < .01), and self-stigma content (β = −.24,
p < .001) were significantly related to life satisfaction, where-
as no significant relationship between self-stigma process and
life satisfaction was found (β = .08, p > .05). For PMI, self-
compassion (β = .22, p < .01) and mindfulness (β = .23,
p < .01) were significantly related to life satisfaction, whereas
self-stigma content (β = −.09, p > .05) and process (β = −.12,
p > .05) were not significantly related to life satisfaction after
controlling for self-compassion and mindfulness.
For PLHIV, the interaction between self-compassion and
self-stigma content was significantly related to life satisfaction
(β = .11, p < .05), whereas the interaction between mindfulness
and self-stigma process was not significant (β = .04, p > .05).
Simple slope analysis showed that when self-compassion was
low, self-stigma content was significantly and negatively as-
sociated with life satisfaction (t = −4.22, p < .05). When self-
compassion was high, the association was not significant

Table 1 Correlations and

independent t tests of M (SD) in M (SD) in t 1 2 3 4 5
psychological variables PLHIV PMI

1. Mindfulness 3.23 (0.40) 3.02 (0.39) 5.70** – .44** −.15* −.48** .38**
2. Self-compassion 3.41 (0.52) 3.12 (0.53) 5.69** .53** – −.32** −.41** .34**
3. Self-stigma content 4.20 (1.30) 3.48 (1.31) 5.74** −.25** −.31** – .38** −.21**
4. Self-stigma process 3.35 (0.69) 3.18 (0.89) 2.15** −.27** −.26** .51** – −.35**
5. Life satisfaction 4.60 (1.22) 4.35 (1.43) 1.95 .37** .41** −.31** −.15* –

Correlation coefficients below lines for PLHIV and above lines for PMI
*
p < .05; ** p < .01
Mindfulness (2017) 8:595–602
Self-compassion
.11*/.06
.27**/.22**
Self-stigma content
-.24**/-.09
Life satisfaction
Self-stigma process
.08/-.12
.20**/.23**
04/.19**
Mindfulness
Fig. 1 Model testing between samples with standardized direct effects
(PLHIV/PMI)
(t = −1.13, p > .05). For PMI, the interaction effect between
mindfulness and self-stigma process was significantly related
to life satisfaction (β = .19, p < .05), whereas the interaction
effect between self-compassion and self-stigma content was
not significant (β = .06, p > .05). Simple slope analysis
showed that when mindfulness was low, self-stigma process
was significantly and negatively associated with life satisfac-
tion (t = −3.16, p < .05). When mindfulness was high, the as-
sociation was not significant (t = 0.08, p > .05).
The alternative model which included interaction effects
not only between self-compassion and self-stigma content
and between mindfulness and self-stigma process but also
between self-compassion and self-stigma process as well as
between mindfulness and self-stigma content was tested. The
results showed significantly poorer model fit compared with
our proposed model, Δχ2(22) = 124.54, p < .05. In addition,
the interaction effects between self-compassion and self-
stigma process (for PLHIV, β = .07, p > .05; for PMI,
β = .14, p > .05) and between mindfulness and self-stigma
content (for PLHIV, β = −.02, p > .05; for PMI, β = −.09,
p > .05) were not significant in the model. It indicated that
the proposed model was more parsimonious and preferred.
Discussion
The present study investigated the moderating roles of self-
compassion and mindfulness in the relationships between self-
stigma content and process with subjective well-being among
PMI and PLHIV. Findings suggested that both mindfulness
and self-compassion were positively associated with well-
being for the two groups while their moderating effects were
group-specific. It is plausible that the specific moderating ef-
fects of self-compassion and mindfulness can be explained by
599
the heterogeneity in the illness experience, social identity, and
the consequences that they have to bear in the society between
PMI and PLHIV.
For PMI, mindfulness buffered against the negative asso-
ciation between self-stigma process and well-being. This find-
ing added further understanding on the role of self-stigma
process and echoed previous research on mindfulness
(Verplanken and Fisher 2014). Different from the findings of
Chan and Mak (2016), self-stigma process imposed no signif-
icant main effect on well-being. However, given that self-
stigma process was correlated with life satisfaction bivariately,
it is plausible that the linkage between self-stigma process and
well-being was not robust in the current sample and its effect
was accounted when controlling for other variables in the path
analysis. Given the limited literature on self-stigma process
and its impact, more studies with empirical evidence are war-
ranted. Relative to PLHIV, PMI are often described in the
mass media with derogatory linguistic references (e.g., mad,
nuts, crazy, psycho). The frequency of the negative thoughts
of their mental illness identity may play a major role in affect-
ing their subjective well-being, and their mental illness iden-
tity becomes more salient than other social identities (Quinn
and Chaudoir 2009; Quinn and Earnshaw 2011). Thus, when
they lack mindfulness, PMI may judge themselves as inferior
to the public frequently and without conscious awareness,
which dispose them to chronic distress and poor well-being.
The findings shed light on the importance of mindfulness for
the well-being of PMI, especially for those who have automat-
ic and frequent self-stigmatizing thoughts. Consistent with the
effect of mindfulness, although individuals frequently think
about themselves negatively, as long as they allow unwanted
thoughts to come and go without automatic reactions, their
subjective well-being may be intact (Verplanken and Fisher
2014). Furthermore, the significant relationships among mind-
fulness, self-stigma process, and well-being among PMI may
be due to the fact that self-stigma process is closely related to
rumination which has been found to be particularly harmful to
the well-being and symptoms (e.g., increased depression and
psychopathologies) of PMI (Nolen-Hoeksema et al. 2008).
Future studies should test the role of rumination in affecting
the current model among PMI and the relationship between
rumination and self-stigma process.
For PLHIV, self-stigma content was significantly related to
subjective well-being and self-compassion moderated this re-
lationship. Although both self-stigma content and process
were higher among PLHIV than PMI, what they thought
about their PLHIV status had more impact on their well-
being than how often they negatively thought about them-
selves. The reason may be that given the most prominent
way of HIV transmission in Hong Kong is through unprotect-
ed sexual intercourse, with much higher percentage of HIV
transmission being observed among men who have sex with
men (Mak et al. 2006; Virtual AIDS Office of Hong Kong
600
2015), the public has low acceptance towards homosexuality
in Hong Kong, and such stigma is morally based and unduly
harsh (Equal Opportunities Commission 2016). As such, the
extent to which PLHIV who have internalized the prevalent
negative stereotypes towards PLHIV in the society has a sig-
nificant impact on their well-being, and this overrides how
much they think about such thoughts. It is consistent with
the finding that when PLHIV perceive that the stigma against
them implies a sexual or moral transgression, they are more
likely to endorse others’ negative judgments, socially with-
draw, and suffer physical and mental health problems
(Young et al. 2007). Furthermore, self-compassion could buff-
er against the negative relationship between self-stigma con-
tent and well-being in PLHIV, which is consistent with the
argument that the understanding and warmth to oneself of-
fered by self-compassion serves as a useful antidote to the
harsh negative self-thoughts (Neff 2003).
The present study demonstrated the group-specific moder-
ating roles of self-compassion and mindfulness in the relation-
ships between self-stigma content and process with well-being
among PMI and PLHIV. Although both of them originate
from Buddhism, they take different paths to promote well-
being. According to our findings, while the ameliorative ef-
fects of self-compassion are specific to self-stigma content, the
salutary effects of mindfulness are specific to self-stigma pro-
cess. In addition, although prior research has established the
detrimental effects of self-stigma content on stigmatized indi-
viduals, it has neglected the role of the process by which
individuals think about the self-stigma content. The present
study found that whether the frequency and automaticity of
the negative thoughts are related to well-being was contingent
on their mindfulness levels, especially for people in recovery
of mental illness. Meanwhile, whether the content of their
stigmatizing thoughts is detrimental to their well-being was
contingent on their level of self-compassion, especially among
PLHIV. Given that the specific moderation effects of self-
compassion and mindfulness in PLHIV and PMI might be
group-specific, it highlights the need to be careful when trying
to generalize the self-stigma models and interventions to dif-
ferent stigmatized groups in future work. Nevertheless, future
studies are encouraged to test the moderating roles of mind-
fulness and self-compassion on self-stigma content and pro-
cess in different samples of PLHIVand PMI as well as in other
stigmatized populations for replication of the findings.
Practically, the findings shed light on several previously
under-examined perspectives when considering interventions
of self-compassion and mindfulness to reduce stigma and pro-
mote well-being. First, the model differences in the two sam-
ples cautioned the generalization of interventions and the need
to account for the heterogeneity of stigmatized groups (e.g.,
illness experience, stigmatizing attributes, stereotype content,
and attributions of being stigmatized). Interventions also need
to differentiate between the effects of self-stigma content
Mindfulness (2017) 8:595–602
versus process. A more integrative perspective is highlighted
that both self-compassion and mindfulness need to be consid-
ered in self-stigma reduction programs since they target at
different self-stigma facets. Although interventions, such as
mindfulness-based stress reduction (Kabat-Zinn 2003),
mindfulness-based cognitive therapy (Teasdale et al. 2000),
and mindful self-compassion training (Germer and Neff
2013), have consistently shown to be effective in promoting
subjective well-being for people living with psychiatric symp-
toms (e.g., Mayhew and Gilbert 2008; Teasdale et al. 2000) or
HIV (e.g., Brion et al. 2014; Brion and Menke 2008), few of
them have specifically examined their relationships with self-
stigma. Our findings provide an alternative approach and en-
courage future self-compassion and mindfulness-based inter-
ventions to target at self-stigma content and process. Through
these interventions, stigmatized individuals can decenter self-
stigmatizing thoughts from themselves, develop kindness and
warmth towards their self-stigmatizing thoughts, recognize
their adversities are shared human experience, and mindfully
extend their self-thoughts beyond their stigmatized status by
embracing both negative and positive aspects of themselves
(Lillis et al. 2009; Yadavaia and Hayes 2012).
Limitations and Future Directions
Several limitations are worth being noted when applying these
findings in future research. First, we only adopted self-report
measures. Future research should adopt different (e.g., implic-
it, physical, behavioral) measuring methods to validate the
findings. Also, the cross-sectional data restricted its ability in
making causal inferences. Experimental studies that induce
self-compassion and/or mindfulness states in different stigma-
tized groups are warranted to draw causality. To examine the
possible utility of long-term training in the diminution of the
negative impact of self-stigma, future work should also utilize
established training methods to cultivate self-compassion and
mindfulness (e.g., Germer and Neff 2013; Kabat-Zinn 2003;
Teasdale et al. 2000). Regarding the sample of PMI, the pres-
ent study has considered individuals with different mental
disorders as a collective group with mental illness. Although
a recent study found no significant difference in the relation-
ship between self-stigma and recovery outcomes across sam-
ples of individuals with psychotic disorders, mood disorders,
and substance use disorders (Mak et al. 2016), future studies
should consider potential differences on the impact of self-
stigma content and process on well-being of individuals
across different mental disorders by examining their effects
separately. Moreover, although a recent meta-analysis focus-
ing on 13 studies examining the effects of mindfulness-based
interventions (which includes mindfulness-, compassion-, and
acceptance-based interventions) for psychosis found a medi-
um effect size (Khoury et al. 2013), and another study also
Mindfulness (2017) 8:595–602
found Chinese with schizophrenia in Hong Kong who partic-
ipated in a mindfulness-based psychoeducation to have signif-
icant improvements in symptoms, functioning, and number
and length of rehospitalization, compared with usual care
(Chien and Lee 2013), given the number of controlled studies
on mindfulness-based interventions for individuals with psy-
chotic disorders was small and the mindfulness-based inter-
ventions used were diverse, heterogeneity in outcomes was
large. As such, caution should be made when applying
mindfulness-based interventions for individuals with psychot-
ic disorders in future studies. Finally, the study should be
replicated with other stigmatized groups to investigate the
moderating effects of mindfulness and self-compassion on
self-stigma content and process.
Compliance with Ethical Standards
Funding This study was funded by the University Direct Grant of the
Chinese University of Hong Kong (Ref No. 2021054 and 2021091) and
the Social Welfare Development Fund (Ref. No R03).
Conflict of Interest The authors declare that they have no conflict of
interest.
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