Decentering and Self-Esteem Regulation in Patients with Depression: The Role of Self-Affirmation and Self-Protection Strategies

Background Self-esteem is considered as transdiagnostic factor and plays an important role in the treatment of psychological disorders such as depression. People regulate their self-esteem following threats (e.g., criticism, rejection) through regulatory strategies such as self-affirmation and self-protection. The current study aims to examine the use of these strategies in patients with depression compared to healthy participants and to further examine the role of decentering as metacognitive process in self-esteem regulation. Methods N = 140 healthy participants (no neurological or psychological disorders) and n = 129 patients with depression recruited from inpatient clinics answered questionnaires online regarding self-esteem, decentering, regulatory strategies and depressive symptoms. Results Group comparisons revealed significantly lower self-esteem, decentering and self-affirmation and significantly more self-protection in patients with depression compared to healthy participants. Network analyses showed strong positive associations between self-esteem, decentering and self-affirmation, and strong negative associations between self-esteem, self-protection and depressive symptoms. The path analysis showed a significant mediation through decentering for self-affirmation using internal resources; the mediation for self-protection was not significant. This is potentially explained by a significant moderating effect of depressive symptoms on the association between decentering and self-protection, resp. self-affirmation. Conclusions The results highlight decentering as a potentially important metacognitive process supporting adaptive self-esteem regulation through self-affirmation. At the same time, the influence of depressive symptoms on the associations between decentering and regulatory strategies suggests that self-esteem regulation processes may differ depending on depression severity.