Top

Mindfulness

Gepubliceerd in:

18-02-2020 | REVIEW

Evaluating the Effectiveness of Mindfulness and Compassion-Based Programs on Shame and Associated Psychological Distress with Potential Issues of Salience for Adult Survivors of Childhood Sexual Abuse: a Systematic Review

Auteurs: Gail Westerman, Elizabeth McCann, Elizabeth Sparkes

Gepubliceerd in: Mindfulness | Uitgave 8/2020

Abstract

Objectives

This systematic review seeks to establish the effectiveness of mindfulness and compassion-based programs for reducing shame and psychological distress in heterogeneous adult populations and identify potential issues of salience towards adult survivors of childhood sexual abuse.

Methods

A systematic review, undertaken to establish the current literature on the subject, incorporated a systematic search of five electronic databases, yielding a sample of 177 potentially relevant papers. One further paper was identified during the hand search process. Following duplicate removal and screening, 16 papers were identified for review. Full-text articles of all 16 papers were independently screened by two researchers, of those nine met the inclusion/exclusion criteria. Quality appraisal of all included studies was independently completed by the same two researchers. Data were extracted and synthesised narratively.

Results

Support in favour of mindfulness and compassion-based programs for the reduction of shame and associated psychological distress among a diverse range of adult populations was seen in all nine studies. Furthermore, increases in self-compassion were observed. Due to the weak methodological quality of included studies, results should be interpreted with caution.

Conclusions

There is evidence to suggest that mindfulness and compassion-based programs present a promising approach for reducing shame-based psychological distress across a range of adult populations. Further research to explore these outcomes in relation to the proposed population—adult survivors of childhood sexual abuse—is not only beneficial but also imperative in such a high shame, difficult to treat population.

volgende artikel Mindfulness-Based Programs for People with Chronic Obstructive Pulmonary Disease: a Mixed Methods Systematic Review

Armstrong, R., Waters, E., & Doyle, J. (2011). Reviews in health promotion and public health. In J. P. T. Higgins & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions version 5.1.0 The Cochrane Collaboration. https://www.handbook.cochrane.org.

•Au T M, Sauer-Zavala, S., King, M. W., Petrocchi, N., Barlow, D. H. & Litz, B. T. (2017). Compassion-based therapy for trauma-related shame and posttraumatic stress: Initial evaluation using a multiple baseline design. Behavior Therapy, 48(2), 207–221. https://doi.org/10.1016/j.beth.2016.11.012.

Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. https://doi.org/10.1093/clipsy/bpg015.CrossRef

Barnard, L. K., & Curry, J. F. (2011). Self-compassion: Conceptualizations, correlates, and interventions. Review of General Psychology, 15(4), 289–303. https://doi.org/10.1037/a0025754.CrossRef

Beck, A. T., Steer, R. A., & Brown, G. K. (1993). Dysfunctional attitudes and suicidal ideation in psychiatric outpatients. Suicidal and Life-Threatening Behavior, 23(1), 11–20.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for Beck depression inventory-II. Psychological Corporation.

Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress and Health, 26(5), 359–371. https://doi.org/10.1002/smi.1305.CrossRef

Brewer, J. A., Worhunsky, P. D., Gray, J. R., Tang, Y.-Y., Weber, J., & Kober, H. (2011). Meditation experience is associated with differences in default mode network activity and connectivity. PNAS, 108(50), 220254–220259.

Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services, 87(1), 43–52. https://doi.org/10.1606/1044-3894.3483.CrossRef

Burlingame, G. M., McClendon, D. T., & Alonso, J. (2011). Cohesion in group therapy. Psychotherapy, 48(1), 34–42.PubMed

Cook, D. R. (1996). Empirical studies of shame and guilt: The Internalized Shame Scale. In D. L. Nathanson (Ed.), Knowing feeling: affect, script and psychotherapy (pp. 132–165). Norton.

Crane, R. (2009). Mindfulness-based cognitive therapy. Routledge.

Critical Appraisal Skills Programme. (2018). CASP qualitative checklist. Retrieved April 20, 2019, from https://casp-uk.net/wp-content/uploads/2018/03/CASP-Qualitative-Checklist-2018_fillable_form.pdf

Cuppage, J., Baird, K., Gibson, J., Booth, R., & Hevey, D. (2018). Compassion focused therapy: Exploring the effectiveness with a transdiagnostic group and potential processes of change. British Journal of Clinical Psychology, 57(2), 240–254. https://doi.org/10.1111/bjc.12162.PubMedCrossRef

Deeks, J. J., Dinnes, J., D'Amico, R., Sowden, A. J., Sakarovitch, C., Song, F., Petticrew, M., & Altman, D. G. (2003). Evaluating non-randomised intervention studies. Health Technology Assessment, 7(27). https://doi.org/10.3310/hta7270.

Deng, Y.-Q., Li, S., & Tang, Y.-Y. (2014). The relationship between wandering mind, depression and mindfulness. Mindfulness, 5(2), 124–128. https://doi.org/10.1007/s12671-012-0157-7.CrossRef

DePrince, A. P., Zurbriggen, E. L., Chu, A. T., & Smart, L. (2010). Development of the trauma appraisal questionnaire. Journal of Aggression, Maltreatment & Trauma, 19(3), 275–299.

Earley, M. D., Chesney, M. A., Frye, J., Greene, P. A., Berman, B., & Kimbrough, E. (2014). Mindfulness intervention for child abuse survivors: A 2.5-year follow-up. Journal of Clinical Psychology, 70(10), 933–941. https://doi.org/10.1002/jclp.22102.PubMedCrossRef

Effective Public Health Practice Project. (1998). Quality assessment tool for quantitative studies. Retrieved April 30, 2019, from https://merst.ca/ephpp/

Feiring, C., & Taska, L. S. (2005). The persistence of shame following sexual abuse: A longitudinal look at risk and recovery. Child Maltreatment, 10(4), 337–349. https://doi.org/10.1177/1077559505276686.PubMedCrossRef

Folette, V. M., La Bash, H. A. J., & Sewell, M. T. (2010). Adult disclosure of a history of childhood sexual abuse: Implications for behavioural psychotherapy. Journal of Trauma & Dissociation, 11(2), 288–243. https://doi.org/10.1080/15299730903502953.CrossRef

Germer, C. K. (2005). Mindfulness: What is it? What does it matter? In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 3–28). Guilford Press.

Germer, C. K., & Neff, K. D. (2013). Self-compassion in clinical practice. Journal of Clinical Psychology, 69(8), 856–867. https://doi.org/10.1002/jclp.22021.PubMedCrossRef

Germer, C. K., & Neff, K. D. (2015). Cultivating self-compassion in trauma survivors. In J. Briere, V. Follette, J. Hopper, D. Rozelle, & D. Rome (Eds.), Mindfulness-orientated interventions for trauma: Integrating contemplative practices. Guilford Press.

Gilbert, P. (2007). Psychotherapy and counselling for depression (3rd ed.). Sage. https://doi.org/10.4135/9781446279830.

Gilbert, P. (2010). Compassion focused therapy: The CBT distinctive features series. Routledge.

Gilbert, P. (2017). Compassion: Concepts, research and applications. Routledge.

Gilbert, P., Clarke, M., Kempel, S., Miles, J. N. V., & Irons, C. (2004). Criticizing and reassuring oneself: An exploration of forms style and reasons in female students. British Journal of Clinical Psychology, 43(1), 31–50.PubMed

•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(6), 353–379. https://doi.org/10.1002/cpp.507.

Goetz, J. L., Keltner, D., & Simon-Thomas, F. (2010). Compassion: An evolutionary analysis and empirical review. Psychological Bulletin, 136(3), 351–374.PubMedPubMedCentral

Goldberg, S. B., Tucker, R. P., Greene, P. A., Simpson, T. L., Kearney, D. J., & Davidson, R. J. (2017). Is mindfulness research methodology improving over time? A systematic review. PLoS One, 12(10), e0187298. https://doi.org/10.1371/journal.pone.0187298.PubMedPubMedCentralCrossRef

•Goldsmith, R. E., Gerhart, J. I., Chesney, S. A., Burns, J. W., Kleinman, B., & Hood, M. (2014). Mindfulness-based stress reduction for posttraumatic stress symptoms: Building acceptance and decreasing shame. Journal of Evidence-Based Complementary and Alternative Medicine, 19(4), 227–234. https://doi.org/10.1177/2156587214533703.

Goss, K., Gilbert, P., & Allan, S. (1994). An exploration of shame measures–I: The Other as Shamer Scale. Personality and Individual Differences, 17(5), 713–717. https://doi.org/10.1016/0191-8869(94)90149-X.CrossRef

Hackshaw, A. (2008). Small studies: Strengths and limitations. European Respiratory Journal, 32(5), 1141–1143. https://doi.org/10.1183/09031936.00136408.PubMedCrossRef

Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559. https://doi.org/10.1177/1745691611419671.PubMedCrossRef

Johnson, E. A., & O’Brien, K. (2013). Self-compassion soothes the savage ego-threat system: Effects on negative affect, shame, rumination, and depressive symptoms. Journal of Social and Clinical Psychology, 32(9), 939–963. https://doi.org/10.1521/jscp.2013.32.9.939.CrossRef

•Judge, L., Cleghorn, A., McEwan, K., & Gilbert, P. (2012). An exploration of group-based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy, 5(4), 420–429. https://doi.org/10.1521/ijct.2012.5.4.420.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. Delacorte.

Kearney, D. J., Malte, C., McManus, C., Martinez, M. E., Felleman, B., & Simpson, T. (2013). Loving-kindness meditation for posttraumatic stress disorder: A pilot study. Journal of Traumatic Stress, 26(4), 426–434. https://doi.org/10.1002/jts.21832.PubMedCrossRef

Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. Science, 330(6006), 932.PubMed

Kim, S., Thibodeau, R., & Jorgensen, S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137(1), 68–96.PubMed

Kimbrough, E., Magyari, T., Langenberg, P., Chesney, M., & Berman, B. (2010). Mindfulness intervention for child abuse survivors. Journal of Clinical Psychology, 66(1), 17–33. https://doi.org/10.1002/jclp.20624.PubMedCrossRef

•Krieger, T., Reber, F., Von Glutz, B., Urech, A., Moser, C. T., Schulz, A., & Berger, T. (2019). An internet-based compassion-focused intervention for increased self-criticism: A randomized controlled trial. Behavior Therapy, 50(2), 430–445. https://doi.org/10.1016/j.beth.2018.08.003.

Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., Evans, A., Radford, S., Teasdale, J., & Dalgleish, T. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112. https://doi.org/10.1016/j.brat.2010.08.003.PubMedCrossRef

Lansky, M. R. (2000). Shame dynamics in the psychotherapy of the patient with PTSD: A viewpoint. Journal of the American Academy of Psychoanalysis, 28(1), 133–146. https://doi.org/10.1521/jaap.1.2000.28.1.133.PubMedCrossRef

Lao, S. A., Kissane, D., & Meadows, G. (2016). Cognitive effects of MBSR/MBCT: A systematic review of neuropsychological outcomes. Consciousness and Cognition, 45, 109–123. https://doi.org/10.1016/j.concog.2016.08.017.PubMedCrossRef

Lee, D. A., Scragg, P., & Turner, S. (2001). The role of shame and guilt in traumatic events: A clinical model of shame-based and guilt-based PTSD. British Journal of Medical Psychology, 74(4), 451–466. https://doi.org/10.1348/000711201161109.PubMedCrossRef

Lev-Weisel, R. (2008). Child sexual abuse: A critical review of intervention and treatment modalities. Children and Youth Services Review, 30, 665–673.

Lewis, H. B. (1971). Shame and guilt in neurosis. International Universities Press.

Lewis, M. (2003). The role of the self in shame. Social Research: An International Quarterly, 70(4), 1181–1204.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–342. https://doi.org/10.1016/0005-7967(94)00075-U.PubMedCrossRef

•Lucre, K. M., & Corten, N. (2013). An exploration of group compassion-focused therapy for personality disorder. Psychology and Psychotherapy: Theory, Research and Practice, 86(4), 387–400. https://doi.org/10.1111/j.2044-8341.2012.02068.x.

Macbeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32, 545–552.PubMed

Mantelou, A., & Karakasidou, E. (2017). The effectiveness of a brief self-compassion intervention program on self-compassion, positive and negative affect and life satisfaction. Psychology, 8(4), 590–610. https://doi.org/10.4236/psych.2017.84038.CrossRef

Matos, M., Duarte, C., Duarte, J., Pinto-Gouveia, J., & Gilbert, P. (2017a). Cultivating the compassionate self against depression: An exploration of processes of change. European Psychiatry, 2017(41), s356. https://doi.org/10.1016/j.eurpsy.2017.02.344.CrossRef

•Matos, M., Duarte, C., Duarte, J., Pinto-Gouveia, J., Petrocchi, N., Basran, J., & Gilbert, P. (2017b). Psychological and physiological effects of compassionate mind training: A pilot randomised controlled study. Mindfulness, 8(6), 1699–1712. https://doi.org/10.1007/s12671-017-0745-7.

Matos, M., Duarte, C., Duarte, J., Pinto-Gouveia, J., & Gilbert, P. (2018). How one experiences and embodies compassionate mind training influences its effectiveness. Mindfulness, 9(5), 1224–1245. https://doi.org/10.1007/s12671-017-0864-1.CrossRef

McLean, L., Steindl, S. R., & Bambling, M. (2018). Compassion-focused therapy as an intervention for adult survivors of sexual abuse. Journal of Child Sexual Abuse, 27(2), 161–175.PubMed

Moher, D., Libarati, A., Tetziaff, J., Altman, D. G., & the PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097.PubMedPubMedCentralCrossRef

Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027.CrossRef

Neff, K. D. (2016). Self-compassion. Retrieved April 20, 2019, from http://self-compassion.org

Neff, K. D., & Dahm, K. A. (2015). Self-compassion: What it is, what it does, and how it relates to mindfulness. In B. Ostafin, M. Robinson, & B. Meier (Eds.), Handbook of mindfulness and self-regulation. Berlin: Springer. https://doi.org/10.1007/978-1-4939-2263-5_10.CrossRef

Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69(1), 28–44. https://doi.org/10.1002/jclp.21923.PubMedCrossRef

Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41(1), 139–154. https://doi.org/10.1016/j.jrp.2006.03.004.CrossRef

Neff, K. D., Whittaker, T. A., & Karl, A. (2017). Examining the factor structure of the self-compassion scale in four distinct populations: Is the use of a total scale score justified? Journal of Personality Assessment, 99(6), 596–607.PubMed

Price, C. (2007). Dissociation reduction in body therapy during sexual abuse recovery. Complementary Therapies in Clinical Practice, 13(2), 116–128.PubMed

•Proeve, M., Anton, R., & Kenny, M. (2018). Effects of mindfulness-based cognitive therapy on shame, self-compassion and psychological distress in anxious and depressed patients: A pilot study. Psychology and Psychotherapy: Theory, Research and Practice, 91(4), 434–449. https://doi.org/10.1111/papt.12170.

Raes, F. (2011). The effect of self-compassion on the development of depression symptoms in a non-clinical sample. Mindfulness, 2(1), 33–36.

Rockman, P. (2016, June 22). Why self-compassion is the new mindfulness. Mindful. https://www.mindful.org/self-compassion-new-mindfulness/

Scheel, C. N., Bender, C., Tuschen-Caffier, B., Brodfuhrer, A., Matthies, S., Hermann, C., Geisse, E. K., Svaldi, J., Brakemeier, E. L., Philipsen, A., & Jacob, G. A. (2014). Do patients with different mental disorders show specific aspects of shame? Psychiatry Research, 220(1–2), 490–495. https://doi.org/10.1016/j.psychres.2014.07.062.PubMedCrossRef

Scheff, T. (2014). The ubiquity of hidden shame in modernity. Cultural Sociology, 8(2), 129–141.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guildford.

Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 12(2), 164–176.

Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and Education in Professional Psychology, 1(2), 105–115.

Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioural Medicine, 21(6), 581–599. https://doi.org/10.1023/A:1018700829825.CrossRef

Slavin, R., & Smith, D. (2009). The relationship between sample sizes and effect sizes in systematic reviews in education. Educational Evaluation and Policy Analysis, 31(4), 500–506. https://doi.org/10.3102/0162373709352369.CrossRef

Slepian, M. L., Kirby, J. N., & Kalokerinos, E. K. (2019). Shame, guilt and secrets on the mind. Emotion. Advance online publication. https://doi.org/10.1037/emo0000542.

Sterne, J. A. C., Matthias, E., & Moher, D. (2011). Chapter 10: Addressing reporting biases. In J. P. T. Higgins & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions. Version 5.1.0 The Cochrane Collaboration. https://www.handbook.cochrane.org.

•Talbot, F., Theriault, J., & French, D. J. (2017). Self-compassion: Evaluation of a psychoeducational website. Behavioural and Cognitive Psychotherapy, 45(2), 198–203. https://doi.org/10.1017/S1352465816000230.

Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. New York: Guildford Press.

Tangney, J. P., Dearing, R. L., Wagner, P. E., & Gramzow, R. (2000). The test of self-conscious Affect-3 (TOSCA-3). George Mason University.

Taylor, T. F. (2015). The influence of shame on posttrauma disorders: Have we failed to see the obvious? European Journal of Psychotraumatology, 6, 1–7. https://doi.org/10.3402/ejpt.v6.28847.CrossRef

Tesh, M., Learman, J., & Pulliam, R. M. (2015). Mindful self-compassion strategies for survivors of intimate partner abuse. Mindfulness, 6(2), 192–201. https://doi.org/10.1007/s12671-013-0244-4.CrossRef

Tirch, D. (2010). Mindfulness as a context for the cultivation of compassion. International Journal of Cognitive Therapy, 3(2), 113–123.

Treleaven, D. A. (2018). Trauma-sensitive mindfulness: Practices for safe and transformative healing. W.W. Norton and Company.

van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2011). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders, 25(1), 123–130. https://doi.org/10.1016/j.janxdis.2010.08.011.PubMedCrossRef

van den Brink, E., & Koster, F. (2015). Mindfulness-based compassionate living: A new training programme to deepen mindfulness with heartfulness. Routledge.

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. Viking Press.

van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Journal of Clinical Psychiatry, 75(6), 559–565. https://doi.org/10.4088/JCP.13m08561.CrossRef

Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1994). The PTSD checklist-civilian version. National Center for PTSD.

Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD checklist for DSM-5 (PCL-5). Retrieved April 30, 2019, from https://www.ptsd.va.gov/professional/assessments/adult-st/ptsd-checklist.asp

Wilkins, C. (2014). Mindfulness, women, and childhood abuse – Turning toward what’s difficult. Social Work Today, 14(2), 10.

Woods, H., & Proeve, M. (2014). Relationships of mindfulness, self-compassion, and meditation experience with shame-proneness. Journal of Cognitive Psychotherapy, 28(1), 20–33.

Xu, M., Purdon, C. L., Seli, P., & Smilek, D. (2017). Mindfulness and mind wandering: The protective effects of brief mediation in anxious individuals. Consciousness and Cognition, 51(2017), 157–165.PubMed

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.PubMed

Titel: Evaluating the Effectiveness of Mindfulness and Compassion-Based Programs on Shame and Associated Psychological Distress with Potential Issues of Salience for Adult Survivors of Childhood Sexual Abuse: a Systematic Review
Auteurs: Gail Westerman
Elizabeth McCann
Elizabeth Sparkes
Publicatiedatum: 18-02-2020
Uitgeverij: Springer US
Gepubliceerd in: Mindfulness / Uitgave 8/2020
Print ISSN: 1868-8527
Elektronisch ISSN: 1868-8535
DOI: https://doi.org/10.1007/s12671-020-01340-7

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Objectives

Methods

Results

Conclusions

Log in om toegang te krijgen

Andere artikelen Uitgave 8/2020

Longitudinal Bidirectional Associations Between Dispositional Mindfulness, Maladaptive Schemas, and Depressive Symptoms in Adolescents

The Centrality of Mindfulness-Related Meditations in Early Buddhist Discourse

Mindfulness-Related Variables and Sexual/Relationship Satisfaction in People with Physical Disabilities

Psychometric Evaluation of the Interpersonal Mindfulness Scale Using Rasch Analysis

The Root Causes of COVID-19 Screech for Compassion

The Influence of Anxiety and Mindfulness on Relationship Quality: an Investigation of Comparative and Dyadic Effects