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08-01-2022 | ORIGINAL PAPER Open Access

Effects of Self-compassion on Diurnal Cortisol Pattern via Positive Affect in Colorectal Cancer Survivors

Rainbow T. H. Ho, Ted C. T. Fong, Adrian H. Y. Wan
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Supplementary Information

The online version contains supplementary material available at https://​doi.​org/​10.​1007/​s12671-021-01786-3.
Both Rainbow Ho and Ted Fong share the co-first authorship.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



Colorectal cancer survivors are at risks of emotional distress and dysregulated diurnal cortisol rhythms. Dispositional self-compassion has been linked with better psychological adjustment and greater positive affect. This study evaluated the associations between self-compassion and the diurnal cortisol pattern, and the role of positive affect and emotional distress in mediating this association, in cancer patients.


This longitudinal study recruited 127 Chinese colorectal cancer survivors, who completed assessments for self-compassion, positive affect, emotional distress, and naturalistic salivary cortisol at baseline. The participants completed follow-up assessments for affect and emotional distress after 2 months (time 2) and the diurnal cortisol pattern after 8 months (time 3). Bootstrapped mediation analysis analyzed the direct and indirect effects of self-compassion on the diurnal cortisol pattern via positive affect and emotional distress.


A structural equation model with latent factors of self-compassion, self-criticism, and emotional distress provided an adequate fit to the data. The direct effects of self-compassion and self-criticism on the diurnal cortisol pattern were not significant (p = 0.11–0.50). Positive affect, but not emotional distress, at time 2 significantly predicted steeper diurnal cortisol slopes at time 3 (β = − 0.22, SE = 0.08, p < 0.01). Self-compassion and self-criticism showed significant negative and positive indirect effects on time 3 diurnal cortisol slopes via time 2 positive affect, respectively.


Our findings support indirect linkages between self-compassion and steeper diurnal cortisol slopes via positive affect. Positive affect may mediate temporal relationships between self-compassion and neuroendocrine functioning in colorectal cancer survivors.

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