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Self-compassion and forgiveness: The protective approach against rejection sensitivity

Year 2015, Volume: 1 Issue: 2, 10 - 21, 05.07.2015
https://doi.org/10.19148/ijhbs.58217

Abstract

The main purpose of this study was to examine the relationship between self-compassion, forgiveness and rejection sensitivity. Participants were 496 university students who completed the Self-compassion Scale, the Trait Forgiveness Scale and the Rejection Sensitivity Questionnaire. The obtained data were analyzed with Pearson Moments Correlation Analysis and Multiple Regression Analysis (MRA). In correlation analysis, forgiveness and self-compassion were negatively related to rejection sensitivity, and forgiveness was also associated with self-compassion.  According Multiple Regression Analysis results, rejection sensitivity was predicted negatively by forgiveness and self-compassion, and also self-compassion is the best predictor for rejection sensitivity. The findings were discussed in light of the related literature.

References

  • Akın, A. (2010). Self-compassion and loneliness. International Online Journal of Educational Sciences, 2, 702-718.
  • Al-Mabuk, R.H., Enright, R.D., & Cardis, P.A. (1995). Forgiveness education with parentally love-deprived late adolescents. Journal of Moral Education, 24, 427- 444.
  • Allen, A. B., Goldwasser, E. R., & Leary, M. R. (2012). Self-compassion and well-being among older adults. Self and Identity, 11(4), 428-453
  • Ayduk, O., Downey, G., & Kim, M. (2001). Rejection sensitivity and depressive symptoms in women. Personality and Social Psychology Bulletin, 27, 868–877.
  • Ayduk, O., Gyurak, A., & Luerssen, A. (2009). Rejection sensitivity moderates the impact of rejection on self-concept clarity. Personality and Social Psychology Bulletin, 35, 1467-1478.
  • Ayduk, Ö., Zayas, V., Downey, G., Cole, A. B., Shoda, Y., & Mischel, W. (2008). Rejection sensitivity and executive control: Joint predictors of borderline personality features. Journal of Research in Personality, 42, 151-168.
  • Baron , R. M., & Kenny, D. A. (1986). Moderator-mediator variables distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
  • Baumeister, R. F., Bushman J., & Campbell, W. K. (2000). Self-esteem, narcissism, and aggression: Does violence result from low self-esteem from threatened egotism? Current Directions in Psychological Science, 9, 26–29.
  • Bowker, J. C., Thomas, K. K., Norman, K. E., & Spencer, S. V. (2011). Mutual best friendship involvement, best friends’ rejection sensitivity, and psychological maladaptation. Journal of Youth and Adolescence, 40, 545-555.
  • Breines, J. G., & Chen, S. (2012). Self-compassion increases self-improvement motivation. Personality and Social Psychology Bulletin, 38, 1133-1143.
  • Crocker, J., & Park, L. E. (2004). The costly pursuit of self-esteem. Psychological Bulletin, 130, 392–414.
  • Deniz, M. E., Kesici Ş., & Sümer A. S. (2008). The validity and reliability study of the Turkish version of Self-compassion Scale. Social Behavior and Personality: An International Journal, 36(9), 1151–1160.
  • Downey, G., & Feldman, S. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70, 1327–1343.
  • Ehnvall, A., Mitchell, P. B., Hadzi-Pavlovic, D., Malhi, G. S., & Parker, G. (2009). Pain during depression and relationship to rejection sensitivity. Acta Psychiatrica Scandinavica, 119, 37-382.
  • Enright, R. D., Gassin, E. A., & Wu, C. (1992). Forgiveness: A developmental view. Journal of Moral Education, 21, 99-114
  • Erman, T. (2001). Rural migrants and patriarchy in Turkish cities. International Journal of Urban and Regional Research, 25, 118–133.
  • Erozkan, A. (2004). Rejection, vulnerability, cognitive appraisal and coping in romantic relationships (Unpublished doctoral dissertation). Karadeniz Technical University, Trabzon.
  • Erozkan, A. (2009). Rejection sensitivity levels with respect to attachment styles, gender, and parenting styles: A study with Turkish students. Social Behavior and Personality, 37, 1-14.
  • Fang, A., Asnaani, A., Gutner, C., Cook, C., Wilhelm, S., & Hofmann, S. G. (2011). Rejection sensitivity mediates the relationship between social anxiety and body dysmorphic concerns. Journal of Anxiety Disorders, 25, 946-949.
  • Fitness, J. (2001). Betrayal, rejection, revenge, and forgiveness: An interpersonal script approach. In Leary, M. R. (Ed). Interpersonal Rejection. New York: Oxford University Press.
  • Freedman, S. R., & Enright, R. D. (1996). Forgiveness as an intervention goal with incest survivors. Journal of Consulting and Clinical Psychology, 64, 983-992.
  • 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.
  • Hargrave, T. D. & Sells, J. N. (1997).The development of a forgiveness scale. Journal of Marital and Family Therapy, 23, 41-62.
  • Hebl, J. H., & Enright, R. D. (1993). Forgiveness as a psychotherapeutic goal with elderly females. Psychotherapy, 30, 658-667.
  • Hu, L. T., & Bentler, P. M. (1999). Cut off criteria for fit indexes in covariance structural analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1-55.
  • Jopling, D. A. (2000). Self-knowledge and the self. New York: Routledge.
  • Karremans, J. C., Van Lange, P. A. M., Ouwerkerk, J. W., & Kluwer, E. S. (2003). When forgiveness enhances psychological well-being: The influence of interpersonal commitment. Journal of Personality and Social Psychology, 84, 1011-1026
  • Kenny, D. A., Korchmaros, J. D., & Bolger, N. (2003). Lower level mediation in multilevel models. Psychological Methods, 8, 115-128.
  • Kocacik, F., Kutlar, A., & Erselcan, F. (2007). Domestic violence against women: A field study in Turkey. The Social Science Journal, 44, 698-720.
  • Krause, N., & Ellison, J. G. (2003). Forgiveness by God, forgiveness of others, and psychological well-being in late life. Journal for the Scientific Study of Religion, 42(1), 77-93.
  • Leary, M. R., Tate, E. B., Allen, A. B., Adams, C. E., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: Implications of treating oneself kindly. Journal of Personality and Social Psychology, 92, 887-904.
  • Lee, W. K., & Bang, H. J. (2010). The effects of mindfulness-based group intervention on the mental health of middle-aged Korean women in community. Stress and Health, 26, 341-348.
  • London, B., Downey, G., Bonica, C., & Paltin, I. (2007). Social causes and consequences of rejection sensitivity. Journal of Research on Adolescence, 17, 481-506.
  • MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32, 545-552.
  • McCarty, C. A., Vander, A., & McCauley, E. (2007). Cognitive features associated with depressive symptoms in adolescence: Directionality and specificity. Journal of Clinical Child & Adolescent Psychology, 36, 147–158.
  • McCullough, M. E., Worthington, E. L., & Rachal, K. C. (1997). Interpersonal forgiving in close relationships. Journal of Personality and Social Psychology, 73, 321-336
  • McDonald, K. L., Bowker, J. C., Rubin, K. H., Laursen, B., & Duchene, M. S. (2010). Interactions between rejection sensitivity and supportive relationships in the prediction of adolescents’ internalizing difficulties. Journal of Youth and Adolescence, 39, 563-574.
  • McIntosh et al. (2008). Forgiving the Perpetrators of the September 11th Attacks: Associations with Coping, Distress, and Religiousness. In Forgiveness: A Sampling of Research Results. Washington, DC: APA Office of International Affairs.
  • Mikolajczyk, R. T., Brzoska, P., Maier, C., Ottova, V., Meier, S., Dudziak, U., … El Ansari, W. (2008). Factors associated with self-rated health status in university students: a cross-sectional study in three European countries. BMC Public Health, 8, 215-224.
  • Neff, K. (2003a). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85–101.
  • Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223−250.
  • Neff, K. D., Hsieh, Y., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity, 4, 263-287.
  • Neff, K. D., & McGehee, P. (2009). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9, 225–240.
  • Neff, K. D., Rude, S. S., & Kirkpatrick, K. L. (2006). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality, 41, 908–916.
  • Orzech, K. M., Shapiro, S. L., Brown, K. W., & McKay, M. (2009). Intensive mindfulness training-related changes in cognitive and emotional experience. Journal of Positive Psychology, 4, 212–222.
  • Ozen, A., Sumer, N., & Demir, M. (2011). Predicting friendship quality with rejection sensitivity and attachment security. Journal of Social and Personal Relationships, 28, 163-181.
  • Pearson, K. A., Watkins, E. R., & Mullan, E. G. (2011). Behaviour Research and Therapy, 49, 597-605.
  • Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48, 757–761.
  • Rimes, K. A., & Wingrove, J. (2011). Pilot study of mindfulness-based cognitive therapy for trainee clinical psychologists. Behavioural and Cognitive Psychotherapy, 39, 25-241.
  • Rodden, J. (2003). Forgiveness, education, public policy: The road not yet taken. Modern Age, Fall, 46(4), 333-341.
  • Rubin, K. H., Bukowski, W. M., & Laursen, B. (2009). Handbook of peer interactions, relationships, and groups. New York, NY: Guilford Press.
  • Sandstrom, M. J., Cillessen, A. H. N., & Eisenhower, A. (2003). Children’s appraisal of peer rejection experiences: Impact on social and emotional adjustment. Social Development, 12, 530-550.
  • Sarıçam, H., & Akın, A. (2013). Affedicilik Ölçeğinin Türkçe Formu: Geçerlik ve güvenirlik çalışması. Hasan Ali Yücel Eğitim Fakültesi Dergisi, 10(1), 37-46.
  • Sastre, M. T. M., Vinsonneau, G., Neto, F., Girard, M., & Mullet, E. (2003). Forgivingness and Satisfaction with Life. Journal of Happiness Studies, 4(3), 323-335.
  • Schroevers, M. J., & Brandsma, R. (2010). Is learning mindfulness associated with improved affect after mindfulness-based cognitive therapy? British Journal of Psychology, 101, 95–107.
  • Shapiro, S. L., Brown, K. W., Thoresen, C., & Plante, T. G. (2011). The moderation of mindfulness-based stress reduction effects by trait mindfulness: Results from a randomized controlled trial. Journal of Clinical Psychology, 67, 267–277.
  • Swann, W. B. (1996). Self-traps: The elusive quest for higher self-esteem. New York: Freeman.
  • Thompson, B. L., & Waltz, J. (2008). Self-compassion and PTSD symptom severity. Journal of Traumatic Stress, 21, 556-558.
  • Wang, J., McDonald, K. L., Rubin, K. H., & Laursen, B. (2012). Peer rejection as a social antecedent to rejection sensitivity in youth: The role of relational valuation. Personality and Individual Differences, 53, 939-942.
  • Wei, M., Liao, K. Y., Ku, T., & Shaffer, P. A. (2011). Attachment, self-compassion, empathy, and subjective well-being among college students and community adults. Journal of Personality, 79, 191-221.
  • Worthington, E. L., Witvliet, J. V. O., Pietrini, P., & Miller, A. J. (2007). Forgiveness, health, and well-being: a review of evidence for emotional versus decisional forgiveness, dispositional forgivingness, and reduced unforgiveness. J Behav Med, 30, 291-302.
  • Yarnell, L. M., & Kristin, D. N. (2013). Self-compassion, interpersonal conflict resolutions, and well-being. Self and Identity, 12, 146–159.
Year 2015, Volume: 1 Issue: 2, 10 - 21, 05.07.2015
https://doi.org/10.19148/ijhbs.58217

Abstract

References

  • Akın, A. (2010). Self-compassion and loneliness. International Online Journal of Educational Sciences, 2, 702-718.
  • Al-Mabuk, R.H., Enright, R.D., & Cardis, P.A. (1995). Forgiveness education with parentally love-deprived late adolescents. Journal of Moral Education, 24, 427- 444.
  • Allen, A. B., Goldwasser, E. R., & Leary, M. R. (2012). Self-compassion and well-being among older adults. Self and Identity, 11(4), 428-453
  • Ayduk, O., Downey, G., & Kim, M. (2001). Rejection sensitivity and depressive symptoms in women. Personality and Social Psychology Bulletin, 27, 868–877.
  • Ayduk, O., Gyurak, A., & Luerssen, A. (2009). Rejection sensitivity moderates the impact of rejection on self-concept clarity. Personality and Social Psychology Bulletin, 35, 1467-1478.
  • Ayduk, Ö., Zayas, V., Downey, G., Cole, A. B., Shoda, Y., & Mischel, W. (2008). Rejection sensitivity and executive control: Joint predictors of borderline personality features. Journal of Research in Personality, 42, 151-168.
  • Baron , R. M., & Kenny, D. A. (1986). Moderator-mediator variables distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182.
  • Baumeister, R. F., Bushman J., & Campbell, W. K. (2000). Self-esteem, narcissism, and aggression: Does violence result from low self-esteem from threatened egotism? Current Directions in Psychological Science, 9, 26–29.
  • Bowker, J. C., Thomas, K. K., Norman, K. E., & Spencer, S. V. (2011). Mutual best friendship involvement, best friends’ rejection sensitivity, and psychological maladaptation. Journal of Youth and Adolescence, 40, 545-555.
  • Breines, J. G., & Chen, S. (2012). Self-compassion increases self-improvement motivation. Personality and Social Psychology Bulletin, 38, 1133-1143.
  • Crocker, J., & Park, L. E. (2004). The costly pursuit of self-esteem. Psychological Bulletin, 130, 392–414.
  • Deniz, M. E., Kesici Ş., & Sümer A. S. (2008). The validity and reliability study of the Turkish version of Self-compassion Scale. Social Behavior and Personality: An International Journal, 36(9), 1151–1160.
  • Downey, G., & Feldman, S. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70, 1327–1343.
  • Ehnvall, A., Mitchell, P. B., Hadzi-Pavlovic, D., Malhi, G. S., & Parker, G. (2009). Pain during depression and relationship to rejection sensitivity. Acta Psychiatrica Scandinavica, 119, 37-382.
  • Enright, R. D., Gassin, E. A., & Wu, C. (1992). Forgiveness: A developmental view. Journal of Moral Education, 21, 99-114
  • Erman, T. (2001). Rural migrants and patriarchy in Turkish cities. International Journal of Urban and Regional Research, 25, 118–133.
  • Erozkan, A. (2004). Rejection, vulnerability, cognitive appraisal and coping in romantic relationships (Unpublished doctoral dissertation). Karadeniz Technical University, Trabzon.
  • Erozkan, A. (2009). Rejection sensitivity levels with respect to attachment styles, gender, and parenting styles: A study with Turkish students. Social Behavior and Personality, 37, 1-14.
  • Fang, A., Asnaani, A., Gutner, C., Cook, C., Wilhelm, S., & Hofmann, S. G. (2011). Rejection sensitivity mediates the relationship between social anxiety and body dysmorphic concerns. Journal of Anxiety Disorders, 25, 946-949.
  • Fitness, J. (2001). Betrayal, rejection, revenge, and forgiveness: An interpersonal script approach. In Leary, M. R. (Ed). Interpersonal Rejection. New York: Oxford University Press.
  • Freedman, S. R., & Enright, R. D. (1996). Forgiveness as an intervention goal with incest survivors. Journal of Consulting and Clinical Psychology, 64, 983-992.
  • 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.
  • Hargrave, T. D. & Sells, J. N. (1997).The development of a forgiveness scale. Journal of Marital and Family Therapy, 23, 41-62.
  • Hebl, J. H., & Enright, R. D. (1993). Forgiveness as a psychotherapeutic goal with elderly females. Psychotherapy, 30, 658-667.
  • Hu, L. T., & Bentler, P. M. (1999). Cut off criteria for fit indexes in covariance structural analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1-55.
  • Jopling, D. A. (2000). Self-knowledge and the self. New York: Routledge.
  • Karremans, J. C., Van Lange, P. A. M., Ouwerkerk, J. W., & Kluwer, E. S. (2003). When forgiveness enhances psychological well-being: The influence of interpersonal commitment. Journal of Personality and Social Psychology, 84, 1011-1026
  • Kenny, D. A., Korchmaros, J. D., & Bolger, N. (2003). Lower level mediation in multilevel models. Psychological Methods, 8, 115-128.
  • Kocacik, F., Kutlar, A., & Erselcan, F. (2007). Domestic violence against women: A field study in Turkey. The Social Science Journal, 44, 698-720.
  • Krause, N., & Ellison, J. G. (2003). Forgiveness by God, forgiveness of others, and psychological well-being in late life. Journal for the Scientific Study of Religion, 42(1), 77-93.
  • Leary, M. R., Tate, E. B., Allen, A. B., Adams, C. E., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: Implications of treating oneself kindly. Journal of Personality and Social Psychology, 92, 887-904.
  • Lee, W. K., & Bang, H. J. (2010). The effects of mindfulness-based group intervention on the mental health of middle-aged Korean women in community. Stress and Health, 26, 341-348.
  • London, B., Downey, G., Bonica, C., & Paltin, I. (2007). Social causes and consequences of rejection sensitivity. Journal of Research on Adolescence, 17, 481-506.
  • MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32, 545-552.
  • McCarty, C. A., Vander, A., & McCauley, E. (2007). Cognitive features associated with depressive symptoms in adolescence: Directionality and specificity. Journal of Clinical Child & Adolescent Psychology, 36, 147–158.
  • McCullough, M. E., Worthington, E. L., & Rachal, K. C. (1997). Interpersonal forgiving in close relationships. Journal of Personality and Social Psychology, 73, 321-336
  • McDonald, K. L., Bowker, J. C., Rubin, K. H., Laursen, B., & Duchene, M. S. (2010). Interactions between rejection sensitivity and supportive relationships in the prediction of adolescents’ internalizing difficulties. Journal of Youth and Adolescence, 39, 563-574.
  • McIntosh et al. (2008). Forgiving the Perpetrators of the September 11th Attacks: Associations with Coping, Distress, and Religiousness. In Forgiveness: A Sampling of Research Results. Washington, DC: APA Office of International Affairs.
  • Mikolajczyk, R. T., Brzoska, P., Maier, C., Ottova, V., Meier, S., Dudziak, U., … El Ansari, W. (2008). Factors associated with self-rated health status in university students: a cross-sectional study in three European countries. BMC Public Health, 8, 215-224.
  • Neff, K. (2003a). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85–101.
  • Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223−250.
  • Neff, K. D., Hsieh, Y., & Dejitterat, K. (2005). Self-compassion, achievement goals, and coping with academic failure. Self and Identity, 4, 263-287.
  • Neff, K. D., & McGehee, P. (2009). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9, 225–240.
  • Neff, K. D., Rude, S. S., & Kirkpatrick, K. L. (2006). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality, 41, 908–916.
  • Orzech, K. M., Shapiro, S. L., Brown, K. W., & McKay, M. (2009). Intensive mindfulness training-related changes in cognitive and emotional experience. Journal of Positive Psychology, 4, 212–222.
  • Ozen, A., Sumer, N., & Demir, M. (2011). Predicting friendship quality with rejection sensitivity and attachment security. Journal of Social and Personal Relationships, 28, 163-181.
  • Pearson, K. A., Watkins, E. R., & Mullan, E. G. (2011). Behaviour Research and Therapy, 49, 597-605.
  • Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48, 757–761.
  • Rimes, K. A., & Wingrove, J. (2011). Pilot study of mindfulness-based cognitive therapy for trainee clinical psychologists. Behavioural and Cognitive Psychotherapy, 39, 25-241.
  • Rodden, J. (2003). Forgiveness, education, public policy: The road not yet taken. Modern Age, Fall, 46(4), 333-341.
  • Rubin, K. H., Bukowski, W. M., & Laursen, B. (2009). Handbook of peer interactions, relationships, and groups. New York, NY: Guilford Press.
  • Sandstrom, M. J., Cillessen, A. H. N., & Eisenhower, A. (2003). Children’s appraisal of peer rejection experiences: Impact on social and emotional adjustment. Social Development, 12, 530-550.
  • Sarıçam, H., & Akın, A. (2013). Affedicilik Ölçeğinin Türkçe Formu: Geçerlik ve güvenirlik çalışması. Hasan Ali Yücel Eğitim Fakültesi Dergisi, 10(1), 37-46.
  • Sastre, M. T. M., Vinsonneau, G., Neto, F., Girard, M., & Mullet, E. (2003). Forgivingness and Satisfaction with Life. Journal of Happiness Studies, 4(3), 323-335.
  • Schroevers, M. J., & Brandsma, R. (2010). Is learning mindfulness associated with improved affect after mindfulness-based cognitive therapy? British Journal of Psychology, 101, 95–107.
  • Shapiro, S. L., Brown, K. W., Thoresen, C., & Plante, T. G. (2011). The moderation of mindfulness-based stress reduction effects by trait mindfulness: Results from a randomized controlled trial. Journal of Clinical Psychology, 67, 267–277.
  • Swann, W. B. (1996). Self-traps: The elusive quest for higher self-esteem. New York: Freeman.
  • Thompson, B. L., & Waltz, J. (2008). Self-compassion and PTSD symptom severity. Journal of Traumatic Stress, 21, 556-558.
  • Wang, J., McDonald, K. L., Rubin, K. H., & Laursen, B. (2012). Peer rejection as a social antecedent to rejection sensitivity in youth: The role of relational valuation. Personality and Individual Differences, 53, 939-942.
  • Wei, M., Liao, K. Y., Ku, T., & Shaffer, P. A. (2011). Attachment, self-compassion, empathy, and subjective well-being among college students and community adults. Journal of Personality, 79, 191-221.
  • Worthington, E. L., Witvliet, J. V. O., Pietrini, P., & Miller, A. J. (2007). Forgiveness, health, and well-being: a review of evidence for emotional versus decisional forgiveness, dispositional forgivingness, and reduced unforgiveness. J Behav Med, 30, 291-302.
  • Yarnell, L. M., & Kristin, D. N. (2013). Self-compassion, interpersonal conflict resolutions, and well-being. Self and Identity, 12, 146–159.
There are 62 citations in total.

Details

Primary Language English
Journal Section Articles
Authors

Halis Sakız This is me

Hakan Sarıçam

Publication Date July 5, 2015
Submission Date July 5, 2015
Published in Issue Year 2015 Volume: 1 Issue: 2

Cite

APA Sakız, H., & Sarıçam, H. (2015). Self-compassion and forgiveness: The protective approach against rejection sensitivity. International Journal of Human and Behavioral Science, 1(2), 10-21. https://doi.org/10.19148/ijhbs.58217