Skip to main content
SpringerLink
Log in

The Mediator Role of Emotion Regulation Processes on Infertility-Related Stress

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

The objective of this study is to investigate gender differences regarding the mediator role of self-compassion and self-judgment on the effects of external shame, internal shame, dyadic adjustment, on infertility-related stress. One hundred and sixty-two women and 147 men with a primary infertility diagnosis completed the following set of self-report measures: Others as Shamer, Experience of Shame Scale, Dyadic Adjustment Scale, Self-Compassion Scale, and Fertility Problem Inventory. Path analyses results revealed that in women self-compassion fully mediated the effect of internal shame on infertility-related stress and partially mediated the effect of dyadic adjustment on this variable, while external shame had only a direct effect. In men self-judgment fully mediated the effect of external and internal shame on infertility-related stress. Dyadic adjustment had only a direct effect on infertility-related stress. In conclusion, there is a distinct role of self-compassion and self-judgment on the relationship between shame and infertility-related stress in men and women. Such differences should be taken into account in psychological interventions with these patients. Future research is warranted to further support our results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Abbey, A., Andrews, F. M., & Halman, L. J. (1991). Gender’s role in responses to infertility. Psychology of Women Quarterly, 15, 295–316. doi:10.1111/j.1471-6402.1991.tb00798.x.

    Article  Google Scholar 

  • Abedinia, N., Ramazanzadeh, F., & Aghssa, M. M. (2003). Relationship between anxiety and depression with duration of pregnancy. Quartenaryy Journal Payesh, 4, 153–158.

    Google Scholar 

  • Andrews, B., Qian, M., & Valentine, J. (2002). Predicting depressive symptoms with a new measure of shame: The experience of shame scale. British Journal of Clinical Psychology, 41, 29–42.

    Article  PubMed  Google Scholar 

  • Berking, M., Wupperman, P., Reichardt, A., Pejic, T., Dippel, A., & Znoj, H. (2008). Emotion-regulation skills as a treatment target in psychotherapy. Behavior Research and Therapy, 46, 1230–1237. doi:10.1016/j.brat.2008.08.005.

    Article  Google Scholar 

  • Blackledge, J. T., & Hayes, S. C. (2001). Emotion regulation in acceptance and commitment therapy [Review]. Journal of Clinical Psychology, 57, 243–255.

    Article  PubMed  CAS  Google Scholar 

  • Boivin, J., & Takefman, J. E. (1995). Stress level across stages of in vitro fertilization in subsequently pregnant and nonpregnant women. Fertility and Sterility, 64, 802–810.

    PubMed  CAS  Google Scholar 

  • Boivin, J., & Takefman, J. E. (1996). Impact of the in vitro fertilization process on emotional, physical and relational variables. Human Reproduction, 11, 903–907.

    Article  PubMed  CAS  Google Scholar 

  • Burns, L. H., & Covington, S. N. (2006). Psychology of infertility. In S. N. Covington & L. H. Burns (Eds.), Infertility counseling: A comprehensive handbook for clinicians. New York: Cambridge University Press.

    Google Scholar 

  • Byrne, B. M. (2010). Structural equation modelling with AMOS: Basic concepts, applications, and programming (2nd ed.). New York: Routledge Academic.

  • Castilho, P., Pinto-Gouveia, J., & Bento, E. (2011). Auto-compaixão: Estudo da validação da versão portuguesa da Escala da Auto-compaixão e da sua relação com as experiências adversas na infância, a comparação social e a psicopatologia [Self-compassion: Validation study of the Portuguese version of the Self-Compassion Scale and its relationship with adverse experiences during childhood, social comparison and psychopathology]. Psychologica, 54, 203–230.

    Google Scholar 

  • Chen, T. H., Chang, S. P., Tsai, C. F., & Juang, K. D. (2004). Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Human Reproduction, 19, 2313–2318.

    Article  PubMed  Google Scholar 

  • Domar, A. D., Broome, A., Zuttermeister, P. C., Seibel, M., & Friedman, R. (1992). The prevalence and predictability of depression in infertile women. Fertility and Sterility, 58, 1158–1163.

    PubMed  CAS  Google Scholar 

  • Eugster, A., & Vingerhoets, A. J. J. M. (1999). Psychological aspects of in vitro fertilization: A review. Social Science and Medicine, 48, 575–589.

    Article  PubMed  CAS  Google Scholar 

  • Galhardo, A., Pinto-Gouveia, J., Cunha, M., & Matos, M. (2011). The impact of shame and self-judgment on psychopathology in infertile patients. Human Reproduction, 26, 2408–2414.

    Article  PubMed  CAS  Google Scholar 

  • Gilbert, P. (2002). Body shame: A biopsychosocial conceptualisation and overview, with treatment implications. In P. Gilbert & J. Miles (Eds.), Body shame: Conceptualisation, research and treatment (pp. 3–54). London: Brunner.

    Google Scholar 

  • Gilbert, P. (2005). Compassion: Conceptualisations, research and use in psychotherapy. London: Routledge.

    Google Scholar 

  • Gilbert, P. (2010a). Compassion focused therapy. London: Routledge.

    Google Scholar 

  • Gilbert, P. (2010b). The compassionate mind. London: Constable & Robinson, Ltd.

    Google Scholar 

  • Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13, 353–379. doi:10.1002/cpp.507.

    Article  Google Scholar 

  • Gomez, R., & Leal, I. (2008). Ajustamento conjugal: Características psicométricas da versão portuguesa da Dyadic Adjustment Scale [Dyadic adjustment: Psychometric properties of the Portuguese version of the Dyadic Adjustment Scale]. Análise Psicológica, 4, 625–638.

  • Goss, K., Gilbert, P., & Allan, S. (1994). An exploration of shame measure: the ‘others as shamer scale’. Personality and Individual Differences, 17, 713–717.

    Article  Google Scholar 

  • Greil, A. L. (1997). Infertility and psychological distress: A critical review of the literature. Social Science and Medicine, 45, 1679–1704. doi:S0277953697001020.

    Article  PubMed  CAS  Google Scholar 

  • Guleç, G., Hassa, H., Gunes, E., & Yenilmez, Ç. (2011). The effects of infertility on sexual functions and dyadic adjustment in couples that present for infertility treatment. Turkish Journal of Psychiatry, 22, 166–176.

    PubMed  Google Scholar 

  • Hayes, S. C., Stroshal, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: The Guilford Press.

    Google Scholar 

  • Irons, C., & Gilbert, P. (2005). Evolved mechanisms in adolescent anxiety and depression symptoms: The role of attachment and social rank systems. Journal of Adolescence, 28, 325–341.

    Article  PubMed  CAS  Google Scholar 

  • Kim, S., Thibodeau, R., & Jorgensen, R. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137, 68–96.

    Article  PubMed  Google Scholar 

  • Kline, R. B. (2005). Principles and practice of structural equation modelling (2nd ed.). New York: The Guilford Press.

    Google Scholar 

  • Klonoff-Cohen, H., & Natarajan, L. (2004). The Concerns During Assisted Reproductive Technologies (CART) scale and pregnancy outcomes. Fertility and Sterility, 81, 982–988. doi:10.1016/j.fertnstert.2003.08.050.

    Article  PubMed  Google Scholar 

  • Lee, T. Y., Sun, G. H., & Chao, S. C. (2001). The effect of an infertility diagnosis on the distress, marital and sexual satisfaction between husbands and wives in Taiwan. Human Reproduction, 16, 1762–1767.

    Article  PubMed  CAS  Google Scholar 

  • Mahajan, N. N., Turnbull, D. A., Davies, M. J., Jindal, U. N., Briggs, N. E., & Taplin, J. E. (2010). Changes in affect and state anxiety across an in vitro fertilization/intracytoplasmic sperm injection cycle. Fertility and Sterility, 93, 517–526. doi:10.1016/j.fertnstert.2008.12.054.

    Article  PubMed  Google Scholar 

  • Matos, M., & Pinto-Gouveia, J. (2010). Shame as a traumatic memory. Clinical Psychology & Psychotherapy, 17, 299–312. doi:10.1002/cpp.659.

    Google Scholar 

  • Menning, B. E. (1980). The emotional needs of infertile couples. Fertility and Sterility, 34, 313–319.

    PubMed  CAS  Google Scholar 

  • Monga, M., Alexandrescu, B., Katz, S. E., Stein, M., & Ganiats, T. (2004). Impact of infertility on quality of life, marital adjustment, and sexual function. Urology, 63, 126–130.

    Article  PubMed  Google Scholar 

  • Moura-Ramos, M., Gameiro, S., Canavarro, M. C., & Soares, I. (2012a). Assessing infertility stress: Re-examining the factor structure of the Fertility Problem Inventory. Human Reproduction, 27, 496–505. doi:10.1093/humrep/der388.

    Article  PubMed  CAS  Google Scholar 

  • Moura-Ramos, M., Gameiro, S., Canavarro, M. C., Soares, I., & Santos, T. A. (2012b). The indirect effect of contextual factors on the emotional distress of infertile couples. Psychology & Health, 27, 533–549. doi:10.1080/08870446.2011.598231.

    Article  CAS  Google Scholar 

  • Neff, K. D. (2003a). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250.

    Article  Google Scholar 

  • Neff, K. D. (2003b). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85–101. doi:10.1080/15298860390129863.

    Article  Google Scholar 

  • Neff, K. D. (2004). Self-compassion and psychological well-being. Constructivism in the Human Sciences, 9, 27–37.

    Google Scholar 

  • Neff, K. D., Kirkpatrick, A., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41, 139–154.

    Article  Google Scholar 

  • Newton, C. R., Sherrard, W., & Glavac, I. (1999). The Fertility Problem Inventory: Measuring perceived infertility-related stress. Fertility and Sterility, 72, 54–62.

    Article  PubMed  CAS  Google Scholar 

  • Pestana, M. H., & Gageiro, J. N. (2005). Análise de dados para as ciências sociais: A complementaridade do SPSS [Data analises for social sciences: The SPSS complementarity]. Lisboa: Edições Sílabo.

  • Peterson, B. D., Newton, C. R., & Rosen, K. H. (2003). Examining congruence between partners’ perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples. Family Process, 42, 59–70.

    Article  PubMed  Google Scholar 

  • Peterson, B. D., Newton, C. R., Rosen, K. H., & Schulman, R. S. (2006). Coping processes of couples experiencing infertility. Family Relations, 55, 227–239.

    Article  Google Scholar 

  • Peterson, B. D., Pirritano, M., Block, J. M., & Schmidt, L. (2011). Marital benefit and coping strategies in men and women undergoing unsuccessful fertility treatments over a 5-year period. [Multicenter Study Research Support, Non-U.S. Gov’t]. Fertility and Sterility, 95, 1759–1763.e1. doi:10.1016/j.fertnstert.2011.01.125.

  • Pinto-Gouveia, J., Galhardo, A., Cunha, M., & Matos, M. (2012). Protective emotional regulation processes towards adjustment in infertile patients. Human Fertility, 15, 27–34. doi:10.3109/14647273.2011.654310.

    Article  PubMed  Google Scholar 

  • Ramazanzadeh, F., Noorbala, A. A., Abedinia, N., & Nazhizadeh, M. M. (2009). Emotional adjustment in infertile couples. Iranian Journal of Reproductive Medicine, 7, 97–103.

    Google Scholar 

  • Schmidt, L., Holstein, B. E., Christensen, U., & Boivin, J. (2005). Communication and coping as predictors of fertility problem stress: Cohort study of 816 participants who did not achieve a delivery after 12 months of fertility treatment. Human Reproduction, 20, 3248–3256.

    Article  PubMed  CAS  Google Scholar 

  • Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28.

    Article  Google Scholar 

  • Tangney, J., & Dearing, R. (2002). Shame and guilt. New York: The Guilford Press.

    Google Scholar 

  • Tangney, J., Wagner, P., & Gramzow, R. (1992). Proneness to shame, proneness to guilt and psychopathology. Journal of Abnormal Psychology, 101, 469–478.

    Article  PubMed  CAS  Google Scholar 

  • Tuzer, V., Tuncel, A., Goka, S., Dogan-Bulut, S., Yursel, F. V., Atan, A., et al. (2010). Marital adjustment and emotional symptoms in infertile couples: Gender differences. Turkish Journal of Medical Science, 40, 229–237. doi:10.3906/sag-0901-17.

    Google Scholar 

  • Verhaak, C. M., Lintsen, A. M., Evers, A. W., & Braat, D. D. (2010). Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment. Human Reproduction, 25, 1234–1240. doi:10.1093/humrep/deq054.

    Article  PubMed  CAS  Google Scholar 

  • Verhaak, C. M., & Smeenk, J. M. J. (2007). Women’s emotional adjustment to IVF: A systematic review of 25 years of research. Human Reproduction Update, 13, 27–36. doi:10.1093/humupd/dm1040.

    Article  PubMed  CAS  Google Scholar 

  • Volgsten, H., Skoog, S. A., Ekselius, L., Lundkvist, O., & Sundstrom, P. I. (2010). Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Fertility and Sterility, 93, 1088–1096. doi:10.1016/j.fertnstert.2008.11.008.

    Article  PubMed  Google Scholar 

  • Wischmann, T., Stammer, H., Scherg, H., Gerhard, I., & Verres, R. (2001). Psychosocial characteristics of infertile couples: A study by the ‘Heidelberg Fertility Consultation Service’. Human Reproduction, 16, 1753–1761.

    Article  PubMed  CAS  Google Scholar 

  • Wright, J., Duchesne, C., Sabourin, S., Bissonnette, F., Benoit, J., & Girard, Y. (1991). Psychological distress and infertility: Men and women respond differently. Fertility and Sterility, 55, 100–108.

    PubMed  CAS  Google Scholar 

  • Zegers-Hochschild, F., Adamson, G. D., de Mouzon, J., Ishihara, O., Mansour, R., Nygren, K.,… Vanderpoel, S. (2009). International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertility and Sterility, 92, 1520–1524. doi:10.1016/j.fertnstert.2009.09.009.

Download references

Acknowledgments

The authors extend their deepest thanks to all the couples who voluntarily participated in this study. The authors also wish to thank the infertility related public services and private clinics that collaborated in data collection and to the Portuguese Fertility Association for the support provided.

Funding

This research has been supported by the first author Ph.D. Grant (SFRH/BD/68392/2010), sponsored by FCT (Portuguese Foundation for Science and Technology).

Author information

Authors and Affiliations

  1. Department of Psychology, Instituto Superior Miguel Torga, Largo da Cruz de Celas, nº1, 3000-132, Coimbra, Portugal

    Ana Galhardo & M. Cunha

  2. CINEICC—Faculty of Psychology and Educational Sciences of the University of Coimbra, Coimbra, Portugal

    Ana Galhardo, M. Cunha, J. Pinto-Gouveia & M. Matos

Authors
  1. Ana Galhardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Cunha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Pinto-Gouveia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Matos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ana Galhardo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Galhardo, A., Cunha, M., Pinto-Gouveia, J. et al. The Mediator Role of Emotion Regulation Processes on Infertility-Related Stress. J Clin Psychol Med Settings 20, 497–507 (2013). https://doi.org/10.1007/s10880-013-9370-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-013-9370-3

Keywords

Search

Navigation