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Abstract
PURPOSE This paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as some of the challenges for addressing gaps. It will guide the direction of future work and the steps needed to develop and advance this approach. METHOD This paper reviews evidence of how evolutionary models such as social rank theory and attachment theory have greatly contributed to our understanding of psychosis and provide a clear rationale and evidence base for the mechanisms of change in CFT for psychosis. It reviews the evidence for outcomes of compassion training more generally, and early feasibility evaluations of CFT for psychosis. RESULTS The process evidence shows that people with psychosis have highly active social rank and threat systems, and the benefits of switching into attachment and care systems, which can support emotion regulation and integrative mind states. The outcomes evidence shows that compassion training impacts not only psychological outcomes, but also physiological outcomes such as neural circuits, immune system, and the autonomic nervous system. Within the psychosis field, outcomes research is still in the early days, but there are good indications of feasibility and a clear path forward for the next steps. CONCLUSIONS CFT for psychosis is an approach that integrates biopsychosocial processes, an integration that's evidenced across each aspect of the model, from theoretical foundations (evolution-informed) to interventions (e.g., body/breath training and relational techniques), to evaluation. Future RCTs are required to understand the effects on biopsychosocial outcomes for people with psychosis.
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Affiliation(s)
- Charles Heriot-Maitland
- Balanced Minds, London, UK
- King's College London, London, UK
- University of Glasgow, Glasgow, UK
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2
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Paranjothy SM, Wade TD. A meta-analysis of disordered eating and its association with self-criticism and self-compassion. Int J Eat Disord 2024; 57:473-536. [PMID: 38366726 DOI: 10.1002/eat.24166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE. METHOD Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted. RESULTS Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88). DISCUSSION Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE. PUBLIC SIGNIFICANCE STATEMENT Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments.
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Affiliation(s)
- Sarah Marie Paranjothy
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
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Vrabel KR, Waller G, Goss K, Wampold B, Kopland M, Hoffart A. Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting. Behav Res Ther 2024; 174:104480. [PMID: 38310672 DOI: 10.1016/j.brat.2024.104480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVE Treatments for eating disorders are moderately effective, with cognitive behavior therapy (CBT) providing the strongest evidence. However, it remains important to investigate other interventions, particularly for eating disorders with greater complexity (e.g., substantial comorbidity; trauma history) or for patients who have not responded adequately to previous treatments. METHOD This randomized controlled trial compared CBT against compassion-focused therapy for eating disorders (CFT-E), where half of the sample had a childhood trauma history. The study was pre-registered and adequately powered. A total of 130 patients were randomly assigned to CBT or CFT-E and were assessed at pre-treatment, post-treatment and one-year follow-up. The primary outcome measure was the total score on the Eating Disorder Examination-Interview (EDE), and secondary outcome measures were the Symptom Checklist-90, Inventory of Interpersonal Problems-64 and Post-Traumatic Symptom Scale. Attrition during treatment was low (13%), suggesting good acceptability. RESULTS Eating pathology (EDE scores) reduced substantially overall, with large effect sizes, and there were no differences between therapies. However, at follow-up, for patients with a childhood trauma history, CFT-E maintained benefits better than CBT. CONCLUSION While both CBT and CFT-E resulted in significant reductions in eating pathology, CFT-E showed superior maintenance of benefits for patients with a history of childhood trauma at one-year follow-up, underlining the necessity of tailored interventions for specific patient subgroups.
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Affiliation(s)
- KariAnne R Vrabel
- Research Institute of Modum Bad, Vikersund, Norway; University of Oslo, Oslo, Norway.
| | | | - Ken Goss
- Coventry Eating Disorder Service, UK
| | - Bruce Wampold
- Research Institute of Modum Bad, Vikersund, Norway; University of Wisconsin, Madison, USA
| | | | - Asle Hoffart
- Research Institute of Modum Bad, Vikersund, Norway
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White M, Thomas A, Aston M, Joy P. "It's beautiful and it's messy and it's tragic": exploring the role of compassion in the eating disorder recovery processes of 2S/LGBTQ + Canadians. J Eat Disord 2024; 12:23. [PMID: 38326869 PMCID: PMC10848359 DOI: 10.1186/s40337-024-00981-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024] Open
Abstract
This research explores experiences of compassion among 2S/LGBTQ + Canadians living with eating disorders in the context of eating disorder treatment and community support. There is a growing body of scholarship showing disparities in eating disorder care for those within 2S/LGBTQ + communities. Among the reported concerns is a potential lack of compassion in eating disorder treatment and recovery settings, something which may serve to exacerbate feelings of isolation and perpetuate misunderstandings of 2S/LGBTQ + people's experiences. In an effort to understand these dynamics more deeply, we conducted semi-structured interviews with 2S/LGBTQ + Canadians who have experienced eating disorder care. The data collected were then subjected to Foucauldian discourse analysis, which produced three interconnected discursive considerations: feeling lack of structural compassion, 2S/LGBTQ + communities as places of respite, and 2S/LGBTQ + caregiving. One of the common threads among these discursive considerations was cis-heteronormativity ingrained in eating disorder treatment settings and health care systems more broadly. Our findings underscore the critical need for more enhanced compassion for 2S/LGBTQ + patients in eating disorder care settings. We conclude that compassion, when implemented on the levels of individual clinicians, policy and procedure, and institutions, may represent an avenue toward disrupting ingrained cis-heteronormativity and the associated discursive power structures contained in health care systems.
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Affiliation(s)
- Megan White
- Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Andrew Thomas
- Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, Canada
| | - Phillip Joy
- Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada.
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Vrabel KR, Bratland-Sanda S. Effects of inpatient treatment on compulsive exercise in adults with longstanding eating disorders: Secondary analysis from a randomized controlled trial with 12-month follow-up. Int J Eat Disord 2024; 57:437-449. [PMID: 38158782 DOI: 10.1002/eat.24108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE This study aimed to examine changes in compulsive exercise among adults with eating disorders (ED) admitted for inpatient treatment in a randomized controlled trial comparing cognitive behavioral therapy (CBT) and compassion-focused therapy (CFT) and whether such changes were influenced by treatment condition, childhood trauma, or level of compulsive exercise. METHOD A total of 130 adults admitted to inpatient treatment for EDs mean (SD) age 30.9 (9.7) years, mean illness duration 14.2 (8.9) years, were randomized to receive CBT or CFT and analyzed using multilevel modeling. Assessments included Eating Disorders Examination - Interview, Compulsive Exercise Test and Childhood Trauma Questionnaire. RESULTS Mean total CET score at baseline was 14.7 (4.0) with no difference between the treatment groups. A total of 63 (48.5%) had CET score ≥ 15, indicating clinical levels. There was an overall time effect on reduction in CET total and all CET subscale scores except Lack of enjoyment, and CFT provided greater reduction compared to CBT on the CET subscale Mood improvements. Patients with clinical CET score levels showed greater reduction on CET total and the subscales Avoidance, Weight, and Rigidity across time compared to persons with non-clinical CET score. Childhood trauma did not predict changes in CET total or subscale scores. DISCUSSION Both CBT and CFT improve overall compulsive exercise. The greater effect of CFT than CBT on exercise as a maladaptive mood regulator calls for further research on how affective oriented psychotherapies can not only reduce compulsive exercise but also promote functional exercise among persons with EDs. PUBLIC SIGNIFICANCE STATEMENT Understanding and addressing compulsive exercise in adults with eating disorders is crucial. This study comparing cognitive-behavioral therapy and compassion-focused therapy shows both improve compulsive exercise. Importantly, compassion-focused therapy has a greater impact as an emotion-focused regulator. This emphasizes the need for further exploration into how emotion-focused therapies can reduce compulsive exercise and promote healthier, functional physical activity for individuals with eating disorders.
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Affiliation(s)
- KariAnne R Vrabel
- Research Institute of Modum Bad, Vikersund, Norway
- Institute of Psychology, University of Oslo, Norway
| | - Solfrid Bratland-Sanda
- Department of Sport, Physical Education and Outdoor Sciences, University of South-Eastern Norway, Bø in Telemark, Norway
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Marques CC, Palmeira L, Castilho P, Rodrigues D, Mayr A, Pina TS, Pereira AT, Castelo-Branco M, Goss K. Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study. Int J Eat Disord 2024; 57:410-422. [PMID: 38124655 DOI: 10.1002/eat.24118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE). METHOD Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion. RESULTS The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up. DISCUSSION Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE. PUBLIC SIGNIFICANCE This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.
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Affiliation(s)
- Cristiana C Marques
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Institute of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Lara Palmeira
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Portucalense Psychology Institute (I2P), Portucalense University, Porto, Portugal
| | - Paula Castilho
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Andreas Mayr
- Department of Medical Biometrics, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Tiago Soares Pina
- Department of Nutrition and Dietetics, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Telma Pereira
- Faculty of Medicine, Institute of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Kenneth Goss
- Coventry & Warwickshire Partnership Trust, Coventry Eating Disorder Service, Coventry, UK
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Heriot‐Maitland C, Gumley A, Wykes T, Longden E, Irons C, Gilbert P, Peters E. A case series study of compassion-focused therapy for distressing experiences in psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:762-781. [PMID: 37635319 PMCID: PMC10946731 DOI: 10.1111/bjc.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Compassion-focused therapy (CFT) is an evolution-informed biopsychosocial approach that seeks to cultivate attachment and care motivational systems and their psychophysiological regulators. These can counteract some of the harmful effects of social threat, inferiority, shame, self-criticism and depression, which are common in people with psychosis and undermine their well-being, social trust and ability to feel safe. This study aimed to test the acceptability of a novel manualized individual CFT intervention for psychosis (CFTp). DESIGN A non-concurrent, multiple-baseline, case series design, with three phases: baseline, intervention and follow-up. METHODS The 26-session CFTp intervention was provided for a sample of eight people with distressing psychotic experiences and a psychosis-related diagnosis. The study aimed to assess acceptability of CFTp and to test clinically reliable improvements while receiving the intervention, compared to a baseline period. RESULTS Seven of eight participants completed the therapy, and clinically reliable improvements were found at both the single-case and group level of analysis. At the single-case level, over half the participants showed improvements in depression (5/7), stress (5/7), distress (5/7), anxiety (4/7) and voices (3/5). One participant showed a deterioration in anxiety (1/7) and dissociation (1/7). At the group level (n = 7), there were significant improvements in depression, stress, distress, voices and delusions. The improvements in voices, delusions and distress were sustained at 6- to 8-week follow-up, but depression and stress dropped slightly to trend-level improvements. CONCLUSIONS CFTp is a feasible and acceptable intervention for psychosis, and further investigation is warranted with a randomized controlled trial.
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Affiliation(s)
- Charles Heriot‐Maitland
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Glasgow Mental Health Research FacilityUniversity of GlasgowGlasgowUK
| | - Andrew Gumley
- Glasgow Mental Health Research FacilityUniversity of GlasgowGlasgowUK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Eleanor Longden
- Psychosis Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
- Division of Psychology and Mental HealthThe University of ManchesterManchesterUK
- Complex Trauma and Resilience Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | | | - Paul Gilbert
- Centre for Compassion Research and Training, College of Health, Psychology and Social CareUniversity of DerbyDerbyUK
- The Compassionate Mind FoundationDerbyUK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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Paetzold I, Schick A, Rauschenberg C, Hirjak D, Banaschewski T, Meyer-Lindenberg A, Boehnke JR, Boecking B, Reininghaus U. Exploring putative therapeutic mechanisms of change in a hybrid compassion-focused, ecological momentary intervention: Findings from the EMIcompass trial. Behav Res Ther 2023; 168:104367. [PMID: 37467549 DOI: 10.1016/j.brat.2023.104367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/07/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
Compassion-focused interventions represent a promising transdiagnostic approach, but the mechanisms involved in hybrid delivery combining face-to-face sessions and an ecological momentary intervention remain unexplored. The current study aimed at exploring associations of putative mechanisms with clinical outcomes at post-intervention/follow-up and mediation of outcome at follow-up by preceding pre-to post-intervention changes in putative mechanisms. The compassion-focused EMIcompass intervention was applied in an exploratory randomized controlled trial (treatment as usual (TAU) vs. TAU + EMIcompass) with youth with early mental health problems. Data was collected before randomization, at post-intervention and at four-week follow-up. We recruited N = 92 participants, N = 46 were allocated to the experimental condition. After control for baseline levels of the target outcomes, baseline-to post-intervention improvement in adaptive emotion regulation was associated with lower levels of clinical outcomes (e.g. psychological distress b = -1.15; 95%CI = -1.92 to -0.39) across time points. We could not detect indirect effects, but we observed associations of change in self-compassion and adaptive emotion regulation with outcomes at follow-up in the mediation analysis (e.g., β = -0.35, 95%CI = -0.52 to -0.16). If successfully targeted by interventions, self-compassion and emotion regulation may be promising putative therapeutic mechanisms of change.
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Affiliation(s)
- Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Dusan Hirjak
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jan R Boehnke
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany; School of Health Sciences, University of Dundee, Dundee, UK
| | - Benjamin Boecking
- Tinnitus Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany; ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK; Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Christoffersen H, Skårderud HR, Vrabel K, Weider S. Self-compassion as a mechanism of change in patients with eating disorders and childhood trauma receiving CFT-E; a study of within-person processes. NORDIC PSYCHOLOGY 2023. [DOI: 10.1080/19012276.2023.2192396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Hedvig Christoffersen
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - Hanna Røed Skårderud
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - KariAnne Vrabel
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Siri Weider
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Matos M, Coimbra M, Ferreira C. When body dysmorphia symptomatology meets disordered eating: The role of shame and self-criticism. Appetite 2023; 186:106552. [PMID: 37024054 DOI: 10.1016/j.appet.2023.106552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
Body Dysmorphic Disorder (BDD) is a serious psychiatric condition that has long been identified as an important risk factor for the development of eating-related difficulties. However, little is known about the mechanisms that might explain this association. Therefore, the current study aimed to explore the link between body dysmorphic symptomatology and disordered eating, and test whether this relationship is mediated by higher levels of shame and self-criticism. This cross-sectional study included 291 women from the community, aged between 18 and 62 years old, who completed self-report measures. Path analysis revealed that BDD symptomatology has not only a direct effect on disordered eating, but also an indirect effect, mediated by shame and self-criticism. The path model revealed a very good fit, accounting for 38% and 31% of internal and external shames' variances, respectively, for 69% of self-criticism variance, and 58% of the variance of disordered eating. These findings seem to suggest that in women with BDD symptomatology, disordered eating may emerge as a compensatory strategy to cope with general feelings of inferiority/defectiveness, particularly in the presence of shame experiences and self-critical attitudes/behaviours. Moreover, this study emphasizes the importance to invest in innovative treatment and prevention approaches for BDD that specifically target shame and self-criticism, such as compassion-based therapies. LEVEL OF EVIDENCE: IV, cross-sectional study.
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Affiliation(s)
- Maria Matos
- University of Coimbra, Portugal; Faculty of Psychology and Educational Sciences of the University of Coimbra, Portugal
| | - Maria Coimbra
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Portugal.
| | - Claudia Ferreira
- University of Coimbra, Portugal; CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Portugal; Faculty of Psychology and Educational Sciences of the University of Coimbra, Portugal
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Katan A, Kelly AC. A daily diary study of self-compassion and adaptive coping behaviours in women with symptoms of bulimia nervosa. J Eat Disord 2023; 11:50. [PMID: 36973822 PMCID: PMC10044766 DOI: 10.1186/s40337-023-00755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Mental health is more than the absence of illness and includes the ability to cope adaptively with stress. To shed light on the factors that promote mental health in people with eating disorders, this daily diary study examined whether daily and trait levels of self-compassion predict adaptive coping behaviours in women with symptoms of bulimia nervosa (BN). METHODS Women (N = 124) who met the DSM-5 criteria for BN completed 2 weeks of nightly measures assessing their daily level of self-compassion and their daily adaptive coping behaviours, namely, their use of problem-solving strategies, seeking and receiving of instrumental social support, and seeking and receiving of emotional social support. RESULTS Multilevel modelling revealed that on days when self-compassion levels were higher than their personal mean level or than the preceding day's level, participants reported greater use of problem-solving strategies, greater seeking and receiving of instrumental social support, and greater receiving of emotional social support. Daily levels of self-compassion, but not increased self-compassion from the preceding day, were associated with emotional support sought. Further, higher trait self-compassion, as measured by participants' mean level of self-compassion over the 2 weeks, was associated with increased seeking and receiving of instrumental and emotional social support but not with problem-solving strategies. All models controlled for participants' daily and mean eating pathology over the 2 weeks, highlighting the unique contribution of self-compassion to adaptive coping behaviours. CONCLUSIONS Results suggest that self-compassion may help individuals with symptoms of BN cope with challenges in their daily life more adaptively, an integral component of positive mental health. The present study is among the first to suggest that the benefits of self-compassion for individuals with eating disorder symptoms may lie not only in facilitating reduced eating pathology, as evidenced by prior research, but also in promoting positive mental health. More broadly, findings underscore the potential value of interventions designed to build self-compassion in individuals with eating disorder symptoms.
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Affiliation(s)
- Aleece Katan
- Department of Psychology, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L 3G1, Canada.
| | - Allison C Kelly
- Department of Psychology, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L 3G1, Canada
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13
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Howard TLM, Williams MO, Woodward D, Fox JRE. The relationship between shame, perfectionism and Anorexia Nervosa: A grounded theory study. Psychol Psychother 2023; 96:40-55. [PMID: 36161754 PMCID: PMC10087809 DOI: 10.1111/papt.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 07/05/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to explore the potential relationship between shame, perfectionism and Anorexia Nervosa (AN) and their impact on recovery from AN. METHOD Semi-structured interviews were conducted with 11 people currently accessing services for AN. Interviews were transcribed and analysed using constructivist-grounded theory methodology. RESULTS A model was developed which found a vicious cycle between shame and perfectionism. Participants tried to alleviate their feelings of shame by striving for perfectionism, however failing caused them more shame. Participants who disclosed childhood trauma believed their shame preceded their perfectionism. Participants who did not disclose trauma either believed their perfectionism preceded shame or they were unsure of which occurred first. Participants' responses suggested the following pathways from perfectionism to AN: needing goals; the need for a perfect life including a perfect body and AN being something they could be perfect at. The pathways identified between shame and AN entailed mechanisms via which AN could be used to escape shame, either by seeking pride through AN, seeking to numb shame through AN, seeking to escape body shame and punishing the self. AN was found to feed back into shame in two ways: when people had AN they felt ashamed when they broke their dietary rules, and also simultaneously people felt ashamed of their AN as they were not able to recover. Shame and perfectionism influenced one another in a cyclical pattern, in which shame drove perfectionism and not attaining high standards led to shame. Shame and perfectionism also impacted on recovery in several ways. AN functioned to numb participants' emotions, becoming part of their identity over time. AN also brought respite from a constant striving towards perfectionism. The need for a perfect recovery also influenced their motivation to engage in treatment, and fear of a return of strong emotions was another deterrent to recovery. CONCLUSION The findings of this paper show perfectionism and shame to both be important in the aetiology and maintenance of AN and to have an impact on recovery from AN.
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Affiliation(s)
- Tina L. M. Howard
- Clinical Psychology, School of PsychologyCardiff UniversityCardiffUK
- Cardiff and Vale University Health BoardCardiffUK
| | - Marc O. Williams
- Clinical Psychology, School of PsychologyCardiff UniversityCardiffUK
- Cardiff and Vale University Health BoardCardiffUK
| | | | - John R. E. Fox
- Clinical Psychology, School of PsychologyCardiff UniversityCardiffUK
- Cardiff and Vale University Health BoardCardiffUK
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14
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Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia-a rapid review. J Eat Disord 2023; 11:23. [PMID: 36793104 PMCID: PMC9933292 DOI: 10.1186/s40337-023-00738-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Understanding of the epidemiology and health burden of eating disorders has progressed significantly in the last 2 decades. It was considered one of seven key areas to inform the Australian Government commissioned National Eating Disorder Research and Translation Strategy 2021-2031, as emerging research had highlighted a rise in eating disorder prevalence and worsening burden-of-illness. The aim of this review was to better understand the global epidemiology and impact of eating disorders to inform policy decision-making. METHODS Using a systematic Rapid Review methodology, ScienceDirect, PubMed and Medline (Ovid) were searched for peer-reviewed studies published between 2009 and 2021. Clear inclusion criteria were developed in consultation with experts in the field. Purposive sampling of literature was conducted, which predominately focused on higher-level evidence (meta-analyses, systematic reviews, and large epidemiological studies), synthesised, and narratively analysed. RESULTS 135 studies were deemed eligible for inclusion in this review (N = 1324). Prevalence estimates varied. Global Lifetime prevalence of any eating disorder ranged from 0.74 to 2.2% in males, and 2.58-8.4% in females. Australian 3-month point-prevalence of broadly defined disorders was around 16% in females. Eating disorders appeared more prevalent in young people and adolescents, particularly females (in Australia: eating disorders ~ 22.2%; disordered eating ~ 25.7%). Limited evidence was found on sex, sexuality and gender diverse (LGBTQI +) individuals, particularly males, who had a six-fold increase in prevalence compared to the general male population, with increased illness impact. Similarly, limited evidence on First Australian's (Aboriginal and Torres Strait Islander) suggests prevalence rates similar to non-Indigenous Australians. No prevalence studies were identified specifically assessing culturally and linguistically diverse populations. Global disease burden of any eating disorder was 43.4 age-standardised disability-adjusted-life-years per 100,000; increasing by 9.4% between 2007 and 2017. Australian's total economic cost was estimated at $84 billion from years-of-life lost due to disability and death, and annual lost earnings ~ $1.646 billion." CONCLUSIONS There is no doubt that eating disorder prevalence and impact are on the rise, particularly in at-risk and understudied populations. Much of the evidence came from female-only samples, and Western, high-income countries which more readily have access to specialised services. Future research should examine more representative samples. There is an urgent need for more refined epidemiological methods to better understand these complex illnesses over time, to guide health policy and development-of-care.
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15
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Kopland MCG, Vrabel K, Melsom L, Hoffart A, Johnson SU. Self-compassion in eating disorders and childhood trauma: A study of within-person effects in a randomized controlled trial. Psychother Res 2023; 33:640-653. [PMID: 36630619 DOI: 10.1080/10503307.2022.2149363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with eating disorders and childhood trauma have clinical presentations that make them less suitable for standard eating disorder treatment. This might be due to high levels of shame and self-criticism. Self-compassion can be a mechanism of change, especially for patients with eating disorders and childhood trauma. METHOD A total of 130 patients with or without childhood trauma were admitted to 13 weeks of inpatient treatment and randomized to either compassion-focused therapy or cognitive-behavioral therapy. Self-compassion and eating disorder symptoms were measured every week. The data were analyzed for within-person effects using multilevel modeling. RESULTS We did not find a within-person effect of self-compassion on eating disorder symptoms. Rather, the analysis indicated that eating disorder symptoms predict self-compassion in the overall sample. However, we found a stronger within-person relationship between self-compassion and eating disorder symptoms in patients with trauma receiving compassion-focused therapy compared to the remaining patients in the study. CONCLUSION Overall, eating disorder symptoms predicted subsequent self-compassion at a within-person level. Patients with trauma in compassion-focused therapy demonstrated a stronger relationship between self-compassion and eating disorder symptoms. More studies with a cross-lagged design are needed to further illuminate self-compassion as a mechanism of change for these patients.Trial registration: ClinicalTrials.gov identifier: NCT02649114.
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Affiliation(s)
| | - Karianne Vrabel
- Modum Bad Psychiatric Hospital, Vikersund, Norway.,Department of Psychology, University of Oslo
| | - Linne Melsom
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Asle Hoffart
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Sverre Urnes Johnson
- Modum Bad Psychiatric Hospital, Vikersund, Norway.,Department of Psychology, University of Oslo
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16
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Sahlan RN, Sala M. Eating disorder psychopathology and negative affect in Iranian college students: a network analysis. J Eat Disord 2022; 10:164. [PMID: 36376982 PMCID: PMC9664660 DOI: 10.1186/s40337-022-00683-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND ED psychopathology is becoming more prevalent in Iran. Negative affect has been found to be an important risk factor in eating disorder (ED) onset in research conducted in Western countries, and is also emerging as a potential vulnerability factor to ED psychopathology in Iran. Network theory offers a novel framework to understand the association between negative affect and ED psychopathology in Iran. The primary aim of the current study was to use network analysis to identify bridge symptoms (i.e., symptoms that activate or weaken symptoms in another cluster) across a negative affect and ED psychopathology network among Iranian college students. We also aimed to identify core symptoms (i.e., nodes that demonstrate the strongest connections to other nodes). METHOD Participants were Iranian college students (n = 637; 60.3% women) who completed the Farsi-eating disorder examination-questionnaire and Farsi-negative affect. We estimated a network of ED symptoms and negative affective states and identified bridge and central symptoms. RESULTS Hostility and shame emerged as central bridge symptoms across the negative affect and ED psychopathology clusters. The most central nodes were strong desire to lose weight, definite fear of losing control over eating, and binge eating episodes. CONCLUSION The negative affective states of hostility and shame may increase vulnerability to ED psychopathology among Iranian college students. Findings have important implications for ED prevention programs that should be examined in future research.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
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17
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The role of body dissatisfaction and self-compassion in pregnancy-related anxiety. J Affect Disord 2022; 313:84-91. [PMID: 35772628 DOI: 10.1016/j.jad.2022.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Women undergo significant physical, physiological, and psychological changes during pregnancy. They are also exposed to sociocultural pressure to meet appearance-related ideals. These pregnancy-related changes and sociocultural appearance-related pressures may place pregnant women at greater vulnerability to developing body dissatisfaction and psychological distress. To date, however, little is known about how sociocultural pressure may influence pregnancy-related anxiety, or factors that may protect against such distress during pregnancy. This study examined whether body dissatisfaction mediated the relationship between appearance-related sociocultural pressure and pregnancy-related anxiety, and whether this relationship was moderated by self-compassion and/or self-criticism. METHOD A cross-sectional sample of 253 pregnant women (Mage = 26.28, SDage = 4.43) completed an online questionnaire measuring sociocultural pressure, body dissatisfaction, pregnancy-related anxiety, and self-compassion. RESULTS Moderated mediation analyses revealed body dissatisfaction fully mediated the relationship between sociocultural pressure and pregnancy-related anxiety. Analyses confirmed the moderating role of self-compassion and self-criticism on the relationship between sociocultural pressure and body dissatisfaction, but not on the relationship between body dissatisfaction and pregnancy-related anxiety. LIMITATIONS The cross-sectional nature of this study limits confirmation of the direction of relationships between sociocultural pressure, body dissatisfaction and pregnancy-related anxiety. CONCLUSIONS While the findings of this study need to be replicated in prospective and longitudinal studies, they suggest that sociocultural pressure to meet appearance-related standards contribute to body dissatisfaction, which in turn may facilitate pregnancy-related anxiety. Self-compassion may protect the body image of pregnant women against negative effects of appearance-related sociocultural pressure.
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18
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Monell E, Clinton D, Birgegård A. Emotion dysregulation and eating disorder outcome: Prediction, change and contribution of self-image. Psychol Psychother 2022; 95:639-655. [PMID: 35332656 PMCID: PMC9543735 DOI: 10.1111/papt.12391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Eating disorders (EDs) are severe disorders with unsatisfactory outcome. Emotion dysregulation and self-image are suggested maintenance factors; this study examined emotion dysregulation as potential predictor and/or mechanism of change in relation to ED outcome, and associations between change in emotion dysregulation and self-image in relation to outcome. DESIGN Registry data from initial and 1-year follow-up assessments for 307 patients with a wide range of EDs in specialized ED treatment were used. METHODS Initial and change (∆) in emotion dysregulation were examined as predictors of 1-year outcome. Direct and indirect associations between ∆emotion dysregulation and ∆self-image as either independent variable or mediator in relation to ∆ED psychopathology as dependent were also examined. RESULTS Higher initial emotion dysregulation was weakly associated with higher follow-up ED psychopathology, but not remission, while relative increase in emotion dysregulation was associated with both higher follow-up psychopathology and increased risk of still having a diagnosis. Change in emotion dysregulation primarily had an indirect effect (through change in self-image), while change in self-image had a direct effect, on change in ED psychopathology improvement (such that improvement in one was associated with improvement in the other). CONCLUSIONS Results identify emotion dysregulation as a potential mechanism of change in relation to ED outcome. However, this association was mainly mediated by change in self-image. Results indicate that, in order to improve emotion regulation as a means to reduce ED psychopathology, improving self-image is essential.
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Affiliation(s)
- Elin Monell
- Department of Clinical NeuroscienceCentre for Psychiatry ResearchKarolinska Institute, and Stockholm Health Care ServicesStockholm County CouncilStockholmSweden,Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
| | - David Clinton
- Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden,Institute for Eating DisordersVilla SultOsloNorway
| | - Andreas Birgegård
- Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
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19
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Body Esteem Explains the Relationship Between Mindful Eating and Self-Compassion: a Mediation Analysis. JOURNAL OF COGNITIVE ENHANCEMENT 2022. [DOI: 10.1007/s41465-022-00252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Research illustrates that high levels of self-compassion are associated with individuals eating in a mindful way. Previous research focusing upon emotional eating behaviours has suggested that body esteem is a mechanism that links self-compassion to eating behaviours, whilst mindful eating relates negatively to emotional eating and displays another, more adaptive way of eating. The present research explored whether body esteem could explain (i.e. mediate) the relationship between mindful eating and self-compassion. Two hundred participants were recruited to participate in a cross-sectional study to investigate the relationship between mindful eating, self-compassion, and body esteem. The present study highlights a positive correlation between mindful eating and body esteem, with a mediation effect being observed for mindful eating on self-compassion via the appearance subscale of body esteem. Possible explanations and future directions are discussed further with an emphasis on the need for more empirical work. In addition, suggestions are provided regarding the inclusion of body esteem within weight management interventions focusing upon mindful eating and self-compassion.
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20
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Geller J, Samson L, Maiolino N, Iyar MM, Kelly AC, Srikameswaran S. Self-compassion and its barriers: predicting outcomes from inpatient and residential eating disorders treatment. J Eat Disord 2022; 10:114. [PMID: 35933458 PMCID: PMC9357312 DOI: 10.1186/s40337-022-00640-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with eating disorders (EDs) experience barriers to self-compassion, with two recently identified in this population: Meeting Standards, or concerns that self-compassion would result in showing flaws or lead to loss of achievements or relationships, and Emotional Vulnerability, or concerns that self-compassion would elicit difficult emotions such as grief or anger. This exploratory study examined the utility of self-compassion and two barriers to self-compassion in predicting clinical outcomes in intensive ED treatments. METHOD Individuals in inpatient (n = 87) and residential (n = 68) treatment completed measures of self-compassion and fears of self-compassion, and ten clinical outcome variables at pre- and post-treatment. RESULTS Pre-treatment self-compassion was generally not associated with outcomes, whereas pre-treatment self-compassion barriers generally were. In both treatment settings, fewer Emotional Vulnerability barriers were associated with improved interpersonal/affective functioning and quality of life, and fewer Meeting Standards barriers were associated with improved readiness and motivation. Interestingly, whereas Meeting Standards barriers were associated with less ED symptom improvement in inpatient treatment, Emotional Vulnerability barriers were associated with less ED symptom improvement in residential treatment. CONCLUSIONS Given that few longitudinal predictors of outcome have been established, the finding that pre-treatment barriers to self-compassion predict outcomes in both inpatient and residential settings is noteworthy. Targeting self-compassion barriers early in treatment may be helpful in facilitating ED recovery.
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Affiliation(s)
- Josie Geller
- Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Lindsay Samson
- Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Nadia Maiolino
- Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Vancouver Coastal Health, Vancouver, Canada
| | - Megumi M Iyar
- Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Psychology, University of British Columbia, Kelowna, Canada
| | - Allison C Kelly
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Suja Srikameswaran
- Eating Disorders Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
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21
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A Comparison Between Self-compassion and Unconditional Self-acceptance: Interventions on Self-blame, Empathy, Shame-, Guilt-Proneness, and Performance. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Geller J, Fernandes A, Srikameswaran S, Pullmer R, Marshall S. Path to practising self-compassion in a tertiary eating disorders treatment program: A qualitative analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:983-997. [PMID: 35411630 DOI: 10.1111/bjc.12370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although self-compassion has been shown to facilitate eating disorder (ED) remission, significant barriers to acquiring this skill have been identified. This is particularly true for tertiary care populations, where ED behaviours provide a valued identity and readiness issues are highly salient. In this research, the voices and perspectives of patients who have recovered as well as those in later stages of tertiary care treatment were captured using qualitative methods. METHODS Seventeen individuals with a lengthy ED history (seven fully recovered, 10 currently in recovery-focused residential treatment) participated in audio recorded interviews. Using a visual timeline, participants described the development of their understanding of self-compassion, barriers to self-compassion and how these barriers were overcome. RESULTS Three processes were identified, reflecting different levels of readiness. Challenging my beliefs involved overcoming cognitive barriers to the concept of self-compassion (i.e. coming to see self-compassion as helpful), and set the stage for dealing with the world around me and rolling up my sleeves, which reflected preparatory (i.e. freeing oneself from difficult life circumstances) and active (i.e. having the courage to do the work) change efforts, respectively. CONCLUSIONS These findings may help patients embarking on tertiary care treatment to envision a roadmap of supportive processes and help clinicians tailor interventions to patient level of readiness for self-compassion.
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Affiliation(s)
- Josie Geller
- St. Paul's Hospital Eating Disorders Program, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Avarna Fernandes
- St. Paul's Hospital Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Suja Srikameswaran
- St. Paul's Hospital Eating Disorders Program, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachelle Pullmer
- St. Paul's Hospital Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Sheila Marshall
- Department of Adolescent Health and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Bicaker E, Racine SE. Protection versus risk? The relative roles of compassionate and uncompassionate self-responding for eating disorder behaviors. Eat Behav 2022; 44:101592. [PMID: 34920209 DOI: 10.1016/j.eatbeh.2021.101592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/14/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Research demonstrates the protective role of self-compassion for eating disorder symptoms. However, studies investigating self-compassion most often use the Self-Compassion Scale, which aggregates the distinct but related constructs of compassionate and uncompassionate self-responding. This study examined differential associations of compassionate and uncompassionate self-responding with positive and negative affect and with a range of eating disorder behaviors (i.e., binge eating, purging, dietary restriction, and excessive exercise). Participants were 547 undergraduate students (59% women, Mage = 20.49, SDage = 1.83) who completed measures of self-compassion, trait affect, and eating disorder behaviors. Compassionate and uncompassionate self-responding were moderately negatively correlated (rs = -0.41 and -0.33, among women and men, respectively). Compassionate self-responding was more strongly related to positive affect, and uncompassionate self-responding was more strongly related to negative affect. Among women, uncompassionate self-responding was related to all eating disorder behaviors controlling for compassionate self-responding, whereas compassionate self-responding was not uniquely related to any eating disorder behavior. Among men, a similar pattern emerged, except that only compassionate self-responding related uniquely to excessive exercise. Results are consistent with studies showing that the presence of uncompassionate self-responding might outweigh the absence of compassionate self-responding in explaining psychopathology. Findings highlight the potential importance of primarily targeting uncompassionate self-responding in eating disorder interventions.
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Affiliation(s)
- Ege Bicaker
- Department of Psychology, McGill University, Montreal, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Canada.
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24
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Kot E, Grzegorzewski P, Kostecka B, Kucharska K. Self-disgust and disgust sensitivity are increased in anorexia nervosa inpatients, but only self-disgust mediates between comorbid and core psychopathology. EUROPEAN EATING DISORDERS REVIEW 2021; 29:879-892. [PMID: 34655142 DOI: 10.1002/erv.2862] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics. METHOD Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory-3, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Disgust Scale-Revised and Self-Disgust Scale. RESULTS AN patients manifested higher self-disgust and disgust sensitivity than HCs. In addition, self-disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups. DISCUSSION Our findings imply the putative role of self-disgust in the development of EDs psychopathology in HCs and in its maintenance in AN patients.
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Affiliation(s)
- Emilia Kot
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Grzegorzewski
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
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25
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Thomason S, Moghaddam N. Compassion-focused therapies for self-esteem: A systematic review and meta-analysis. Psychol Psychother 2021; 94:737-759. [PMID: 33215861 DOI: 10.1111/papt.12319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/17/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To identify whether compassion-focused therapy (CFT) or compassion-based interventions are effective in improving self-esteem. METHODS Databases (CINAHL, MEDLINE, and PsycINFO) were searched, along with OpenGrey literature. Experts were also contacted and handsearching of reference lists and citing articles undertaken. To be eligible, papers had to include an intervention identified as being compassion-based and mention 'self-esteem' as a variable or outcome. Papers were quality appraised using the Mixed Methods Appraisal Tool. Data were analysed using a random-effects meta-analysis model, with sensitivity analysis conducted in relation to the quality of studies. RESULTS Ten eligible papers were identified. Within-group analysis of data from eight studies demonstrated a medium, significant overall effect size (g = 0.56, 95% CI [0.19-0.93], z = 3.54, p < .001), which increased slightly and remained significant (g = 0.61, 95% CI [0.05-1.17], z = 2.82, p = .005) when the lowest quality studies were removed. CONCLUSIONS Compassion-focused therapy or compassion-based interventions may be effective in improving self-esteem. However, there is large clinical and methodological heterogeneity amongst studies making further conclusions difficult. PRACTITIONER POINTS CFT/compassion-based interventions appear to be effective in improving self-esteem. Transdiagnostic concepts (such as low self-esteem and compassion-focused therapy) should be considered in supporting people with their mental health.
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Irons C, Heriot-Maitland C. Compassionate Mind Training: An 8-week group for the general public. Psychol Psychother 2021; 94:443-463. [PMID: 33222375 DOI: 10.1111/papt.12320] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/26/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES There is an increasing interest in how compassion training, and in particular, the cultivation of self-compassion may be an important component in the reduction of distress and promotion of well-being. Compassion Focused Therapy (CFT) has shown promising results in this area, with positive outcome studies in a wide range of mental health problems. However, following the successful development of short mindfulness-based programmes (e.g., Mindfulness-based Stress Reduction and Mindfulness-based Cognitive Therapy) and compassion/self-compassion programmes (e.g., Mindful Self-Compassion) that can be accessed by the general public, we were keen to develop and research an 8-week Compassionate Mind Training (CMT) course, based on the CFT model. DESIGN Within-subjects pre-to-post-group comparison. METHODS Following an 8-week CMT groups, participants in the general population (n = 55) completed pre- and post-measures (with 22 of these also providing 3-month follow-up data) on self-compassion, compassion for others, compassion from others, attachment, self-criticism, positive emotion, well-being, and distress. RESULTS Significant increases in compassion, self-reassurance, social rank, positive emotions, and well-being were found, alongside reductions in self-criticism, attachment anxiety, and distress. Changes were maintained at 3-month follow-up. Change scores indicated the importance of increases in self-compassion and reductions in self-criticism in overall improvements in well-being and psychological distress. CONCLUSIONS Findings offer preliminary support for the usefulness of group CMT in community samples. PRACTITIONER POINTS Compassionate Mind Training (CMT) groups appear to be applicable and beneficial in community samples. CMT psychoeducation and practices appear to bring positive changes to a variety of psychological processes, including attachment, self-criticism, self-compassion, well-being, and distress. Further studies are required to investigate whether the mechanisms through which CMT is beneficial.
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Stroud J, Griffiths C. An evaluation of compassion-focused therapy within adult mental health inpatient settings. Psychol Psychother 2021; 94:587-602. [PMID: 33629804 DOI: 10.1111/papt.12334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to examine the effectiveness of a compassion-focused therapy (CFT) group in improving patient outcomes compared to those receiving treatment as usual (TAU) with a trans-diagnostic population who are inpatients within an acute psychiatric ward. DESIGN Quantitative data were gathered as part of routine clinical practice within three adult psychiatric wards using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at admission and discharge and non-standardized Likert scales pre- and post-group sessions. METHOD Between April and August 2017, the Acute Psychology Service (APS) gathered CORE-OM admission and discharge data from inpatients across three acute wards (n = 32) whilst 249 pre/post-group data sets were gathered from CFT group work undertaken on the inpatient wards. Current inpatients self-allocated to receive either CFT or TAU based on their desire for psychological involvement. Those self-allocating to receive psychological involvement (n = 19) were compared to those who did not (n = 13) across the four subdomains of the CORE-OM: Wellbeing, Functioning, Problem/Symptoms, and Risk. The Likert scales included subdomains to evaluate changes in self-compassion, compassion to others, and threat. Those receiving CFT group work also received TAU. RESULTS Significant improvements to all CORE-OM subdomains were observed for those receiving CFT group input, in particular the Wellbeing and Functioning subdomains. Those receiving TAU only noted a significant improvement in the area of Risk whilst levels of Wellbeing were identical at admission and discharge with no improvements noted. Pre/post-group results indicated significant results for areas of self-compassion and compassion to others, whilst results by session for the threat subdomain are mixed dependant on session. Overall, all areas noted significant improvements. Session content was observed to be most effective for breathing and Mindfulness-based sessions and those utilizing imagery techniques. CONCLUSION Compassion-Focused Therapy appears to be an effective group intervention for a trans-diagnostic population within adult inpatient settings. Patient outcomes are positively improved across a range of areas whilst undertaking psychological input in the form of CFT group work whilst also receiving TAU during an inpatient admission. The use of the CFT model to address trans-diagnostic difficulties supports targeting underlying psychological constructs in comparison to symptom treatment alone. PRACTITIONER POINTS Compassion-focused therapy is a multi-model approach designed to target high levels of self-criticism. Previous research has demonstrated its effectiveness for a range of specific diagnosis; however, there is a limited research base with open groups and a trans-diagnostic population. Groups can be structured with standalone sessions to accommodate the unpredictable admissions and discharge patterns of acute psychiatric wards. Group sessions focused around Mindfulness and Imagery yielded the greatest significant improvements to pre-sessions scores. The provision of compassion-focused therapy groups within trans-diagnostic inpatient settings is feasible and has shown to significantly improve overall levels of distress and risk compared to those receiving treatment as usual. The lack of standardized Likert group measures limits the power of the study. Whilst a RCT would provide more reliable data, this was not possible as part of routine clinical practice for ethical reasons.
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Affiliation(s)
- James Stroud
- 1st affiliation Hywel Dda Health Board, NHS Wales, UK.,Myddfai Psychological Wellbeing Centre, Cardiff University, Carmarthen, UK
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Katan A, Kelly AC. A two-week daily diary study examining the association between daily self-compassion and symptoms of bulimia nervosa. Int J Eat Disord 2021; 54:1438-1448. [PMID: 33998025 DOI: 10.1002/eat.23533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Individuals with symptoms of bulimia nervosa (BN) are more likely to binge and purge on days of greater negative affect. Given that self-compassion helps individuals cope more adaptively with distress, the present study examined the contribution of daily fluctuations in self-compassion to eating disorder symptoms in women who endorse symptoms of BN. The directionality of these associations was also examined. METHOD For 2 weeks, 124 women who met the DSM-5 criteria for BN completed nightly measures of their daily eating pathology and self-compassion. RESULTS Self-compassion levels varied almost as much within a person from day-to-day as between-persons (i.e., from one person to the next). Multilevel modeling revealed that within persons, higher daily levels of self-compassion were associated with a reduced probability of both binge eating and inappropriate compensation, and lower levels of dietary restraint and clinical impairment. Secondary analyses revealed that these variables mutually influenced one another within but not across days. Between persons, higher mean levels of self-compassion over the 2 weeks were associated with less dietary restraint and clinical impairment but were unrelated to binge eating and compensatory behaviors. DISCUSSION For women who report symptoms consistent with BN, responding to daily distress with greater self-compassion than usual may attenuate the psychosocial and behavioral symptoms of their eating disorder. Similarly, days of reduced eating pathology may facilitate self-compassion. Future research using experimental paradigms and ecological momentary assessments may shed further light on the ways in which self-compassion and eating pathology relate to one another in this population.
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Affiliation(s)
- Aleece Katan
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Allison C Kelly
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
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O’Driscoll D, McAleese M. The feasibility and effectiveness of compassionate mind training as a test anxiety intervention for adolescents: A preliminary investigation. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wakelin KE, Perman G, Simonds LM. Effectiveness of self-compassion-related interventions for reducing self-criticism: A systematic review and meta-analysis. Clin Psychol Psychother 2021; 29:1-25. [PMID: 33749936 DOI: 10.1002/cpp.2586] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Abstract
Self-criticism is the process of negative self-evaluation. High levels are associated with psychopathology and poorer therapeutic outcomes. Self-compassion interventions were developed to explicitly target self-criticism. The aim of this review was to estimate the overall effect of self-compassion-related interventions on self-criticism outcomes and investigate potential moderating variables. A systematic search of the literature identified 20 randomized controlled trials (RCTs) that met the inclusion criteria. Nineteen papers, involving 1350 participants, had sufficient data to be included in the meta-analysis. Pre- and post-data points were extracted for the compassion and control groups. Study quality was assessed using an adapted version of the Cochrane Collaboration's risk of bias tool, which concluded that studies were of moderate quality. Meta-analysis findings indicated that self-compassion-related interventions produce a significant, medium reduction in self-criticism in comparison with control groups (Hedges' g = 0.51, 95% CI [0.33-0.69]). Moderator analysis found greater reductions in self-criticism when self-compassion-related interventions were longer and compared with passive controls rather than active. The remaining moderators of forms of self-criticism, sample type, intervention delivery, intervention setting and risk of bias ratings were insignificant. Overall, the review provides promising evidence of the effectiveness of self-compassion-related interventions for reducing self-criticism. However, results are limited by moderate quality studies with high heterogeneity. Directions for future research indicate that more RCTs with active controls, follow-ups, consistent use and reporting of measures and diverse samples are needed.
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Affiliation(s)
| | - Gemma Perman
- School of Psychology, University of Surrey, Guildford, UK
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Bratt AS, Rusner M, Svensson I. An exploration of group-based compassion-focused therapy for adolescents and their parents. Scand J Child Adolesc Psychiatr Psychol 2021; 8:38-47. [PMID: 33520777 PMCID: PMC7685492 DOI: 10.21307/sjcapp-2020-005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background The long-term negative consequences of mental health problems during adolescence highlight the need for effective treatments. Compassion-focused therapy (CFT) aims to help individuals to enhance their ability to support and care for themselves and to alleviate shame and self-stigmatization. Objective This non-randomized controlled trial examined the effectiveness of group-based CFT on perceived stress and the extent of self-compassion in a clinical sample of adolescents receiving psychiatric care for complex mental health difficulties and their parents. Method The participants were 43 adolescents (ages 14-17; 83.7 % female) under treatment at a child and adolescent psychiatric outpatient clinic in Sweden and their parents (n = 77; 61 % female). The adolescents volunteered for group-based CFT (n = 19); if they did not want to participate, they were asked to join the control group receiving treatment as usual (TAU, n = 24). The CFT parents were given the same treatment as their children in parallel parent groups. The participants completed questionnaires measuring self-compassion and perceived stress before and after treatment. Paired samples t-tests and independent samples t-tests assessed the within-group and between-group differences via change scores. Results The fathers scored highest on self-compassion and had less perceived stress at both times than the adolescents or mothers. There were no significant differences between the CFT and TAU groups in self-compassion or perceived stress at either time, and the effect sizes were small (g ≤ 0.25). The TAU mother group was the only group with a significantly changed mean self-compassion score post-treatment. Conclusions Some patients seem to benefit from group-based CFT in ways similar to the benefits of specialized therapeutic approaches. Further research into the utility of CFT for adolescents with MH problems and their parents, as well as the long-term clinical effects of CFT for this group is needed.
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Affiliation(s)
- Anna Sofia Bratt
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Kronoberg, Sweden
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenbrg, Sweden.,Region Västra Götaland, Södra Ävlsborg Hospital, Dep. of Research, Borås, Sweden
| | - Idor Svensson
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Kronoberg, Sweden
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Kelly A, Katan A, Sosa Hernandez L, Nightingale B, Geller J. Why would I want to be more self-compassionate? A qualitative study of the pros and cons to cultivating self-compassion in individuals with anorexia nervosa. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:99-115. [PMID: 33368387 DOI: 10.1111/bjc.12275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although self-compassion facilitates eating disorder symptom remission, individuals with eating disorders are fearful of developing it and higher fears of self-compassion are associated with poorer treatment outcomes. In-depth exploration of individuals' pros and cons of behaviour change is generally helpful at resolving ambivalence; however, no research has examined the pros and cons individuals with eating disorders perceive to be associated with developing self-compassion, limiting our understanding of their personal experiences when confronted with self-compassion. Given the research suggesting higher resistance to self-compassion development in individuals with anorexia nervosa (AN), the present study used qualitative methods to gain a deeper understanding of their perceived pros and cons to self-compassion. METHODS Thirty-seven women with typical (64%) and atypical (36%) AN signed up for a study on self-help strategies for daily distress. Upon learning that the intervention would entail cultivating self-compassion, they identified their perceived pros and cons of developing self-compassion by typing them out. RESULTS Thematic analysis was used to extract themes. Three superordinate cons and four superordinate pros of self-compassion emerged. Perceived cons were as follows: self-compassion leading to personal shortcomings; apprehension and doubt about the efficacy of self-compassion; and emotional challenges associated with developing self-compassion. Perceived pros were as follows: improved health; personal development (e.g., growth, coping); improved outlook; and enhanced social relationships. CONCLUSIONS These findings reveal the various advantages and disadvantages that women with AN perceive to be associated with developing self-compassion. Results may help clinicians work more sensitively and effectively when trying to cultivate self-compassion in patients who have AN. PRACTITIONER POINTS This research suggests that patients with anorexia nervosa (AN) perceive various disadvantages to cultivating self-compassion, but also certain advantages. By familiarizing themselves with the pros and cons to self-compassion identified by individuals with AN, clinicians may be able to more effectively listen to and communicate with their patients about ambivalence about self-compassion development. Clinicians may want to listen for and explore concerns in their AN patients that self-compassion will lead to personal shortcomings, fail to be beneficial, and be emotionally challenging. Clinicians may want to listen for and help patients elaborate upon their beliefs about how self-compassion might benefit their outlook, health, personal development, and relationships.
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Affiliation(s)
- Allison Kelly
- Department of Psychology, University of Waterloo, Waterloo, Ontoria, Canada
| | - Aleece Katan
- Department of Psychology, University of Waterloo, Waterloo, Ontoria, Canada
| | | | | | - Josie Geller
- St. Paul's Hospital, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Unburdening the Weight of Stigma: Findings From a Compassion-Focused Group Program for Women With Overweight and Obesity. J Cogn Psychother 2020; 34:336-357. [PMID: 33372127 DOI: 10.1891/jcpsy-d-20-00015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to develop a 2-day intensive-format, Compassion-Focused Therapy (CFT) based group program targeting weight stigma in women with overweight and obesity, and to conduct a pilot study to determine the feasibility and acceptability of the intervention. METHOD Participants were 15 females aged 18-62 years (mean [M] = 43.60, standard deviation [SD] = 12.38), who participated in the program and completed measures of self-compassion, internalized weight stigma, psychological distress, life-satisfaction, loneliness, eating self-efficacy, body dissatisfaction, and body shame, at pre-treatment, post-treatment, and 3-month follow-up. RESULTS Significant improvements were found from pre-treatment to post-treatment for self-compassion and internalized weight stigma, with gains maintained at 3-month follow-up. Significant improvements were also found on measures of psychological distress, life satisfaction, loneliness, eating self-efficacy, and body dissatisfaction at the post-treatment assessment. Credibility ratings of the program were high. CONCLUSIONS This study has contributed to existing stigma research, being the first proof-of-concept study to demonstrate support for an intensive, CFT based group approach targeting the effects of weight stigma for women with overweight and obesity. The findings are discussed in terms of the potential of CFT to assist women develop resilience to the harmful effects of weight stigma, and possible future research directions to further develop and evaluate this approach.
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Perey I, Koenigstorfer J. Appearance Comparisons and Eating Pathology: A Moderated Serial Mediation Analysis Exploring Body Image Flexibility and Body Appreciation as Mediators and Self-Compassion as Moderator. Body Image 2020; 35:255-264. [PMID: 33157399 DOI: 10.1016/j.bodyim.2020.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/27/2020] [Accepted: 09/27/2020] [Indexed: 01/26/2023]
Abstract
Comparing one's body against the bodies of others is related to lower positive body image and higher eating pathology. Underlying mechanisms as well as protective factors of these relationships are yet to be discovered. The present study examined body image flexibility and body appreciation as potential mediators of the association between appearance comparisons and eating disorder psychopathology. Additionally, it was tested whether self-compassion moderates the mediation effects. In an online sample comprising 250 women (Mage = 42.66, SD = 12.24), the inverse relationship between appearance comparisons and body appreciation was mediated by body image flexibility and the positive relationship between appearance comparisons and eating disorder psychopathology was mediated by body image flexibility and serially mediated by body image flexibility and body appreciation, when controlling for body mass index and age. Simple mediations were further moderated by self-compassion, such that indirect effects were attenuated at high levels of self-compassion. Promoting body image flexibility may be one potential target for helping women to engage in less maladaptive and more adaptive ways of treating the body when comparing one's appearance. Building self-compassion may be another potential target that may protect body image flexibility and its correlates in the face of appearance comparisons.
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Affiliation(s)
- Iris Perey
- Chair of Sport and Health Management, Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Joerg Koenigstorfer
- Chair of Sport and Health Management, Department of Sport and Health Sciences, Technical University of Munich, Germany.
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Zhou Y, Pennesi JL, Wade TD. Online imagery rescripting among young women at risk of developing an eating disorder: A randomized controlled trial. Int J Eat Disord 2020; 53:1906-1917. [PMID: 32864755 DOI: 10.1002/eat.23370] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study compared the effectiveness of two approaches to imagery rescripting (body versus general) among young women with an elevated risk of developing an eating disorder. METHOD University students (N = 130 females) were randomly assigned to one of the four conditions: body or general imagery rescripting, psychoeducation, control. After initial brief laboratory training delivered online, participants in the imagery rescripting conditions were asked to practice imagery rescripting for 5 min each day for a week. Primary (global eating psychopathology, eating disorder behaviors, and body image acceptance) and secondary outcomes (self-compassion, fear of self-compassion, and dysfunctional attitudes) were measured at baseline and one-week follow up. RESULTS Completer analyses showed both imagery rescripting conditions and psychoeducation had significant impact on global eating psychopathology and body acceptance (d = 0.60-0.78). Psychoeducation did not impact secondary variables, whereas body imagery rescripting improved self-compassion and fear of self-compassion (d = 0.61-0.80) and general imagery rescripting improved dysfunctional attitudes (d = 0.82) compared to control. Intent to treat analyses had similar but slightly less robust results. DISCUSSION While three active groups had significant impact on the primary variables, imagery rescripting approaches had impact on other variables that maintain disordered eating. Future research should investigate the impact of combining psychoeducation and imagery rescripting in terms of impact on disordered eating.
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Affiliation(s)
- Yuan Zhou
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Jamie-Lee Pennesi
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Tracey D Wade
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
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Steindl SR, Buchanan K, Goss K, Allan S. Compassion focused therapy for eating disorders: A qualitative review and recommendations for further applications. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12126] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Stanley R. Steindl
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia,
| | - Kiera Buchanan
- Centre for Integrative Health, Brisbane, Queensland, Australia,
| | - Kenneth Goss
- Coventry & Warwickshire Partnership Trust, Coventry Eating Disorder Service, Coventry, UK,
| | - Steven Allan
- Clinical Psychology Unit, University of Leicester, Leicester, UK,
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Koller KA, Thompson KA, Miller AJ, Walsh EC, Bardone-Cone AM. Body appreciation and intuitive eating in eating disorder recovery. Int J Eat Disord 2020; 53:1261-1269. [PMID: 32020677 DOI: 10.1002/eat.23238] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/24/2019] [Accepted: 01/19/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Eating disorder recovery research has emphasized the absence of symptoms over the presence of adaptive aspects like positive body image and healthy eating attitudes. The current study examined how body appreciation and intuitive eating related to eating disorder recovery using a comprehensive recovery definition (physical, behavioral, and cognitive recovery). METHOD Data were collected from 66 women with an eating disorder history and 31 controls with no history of eating pathology. Participants completed an online survey followed by a phone interview. RESULTS The fully recovered group did not differ from controls on body appreciation, with both groups endorsing significantly higher levels of body appreciation than the partially recovered and current eating disorder groups. Similarly, the fully recovered group did not differ from controls on overall intuitive eating, with both groups endorsing significantly higher levels of overall intuitive eating than the partially recovered and current eating disorder groups. DISCUSSION Positive psychological constructs such as body appreciation and intuitive eating relate to eating disorder recovery status. Understanding recovery within a strengths-based framework may inform intervention and relapse prevention.
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Affiliation(s)
- Katherine A Koller
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine A Thompson
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandra J Miller
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily C Walsh
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna M Bardone-Cone
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Geller J, Kelly AC, Samson L, Iyar MM, Srikameswaran S. The relation between two barriers to self-compassion and clinical characteristics in individuals with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:766-772. [PMID: 33462868 DOI: 10.1002/erv.2764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 06/22/2020] [Indexed: 11/11/2022]
Abstract
There is growing support for the role of self-compassion in recovery from an eating disorder (ED) and two types of barriers have been identified in this population: (a) fears that self-compassion will result in a failure to meet personal and interpersonal standards (meeting standards); and (b) fears that self-compassion gives rise to difficult emotions such as grief and unworthiness (emotional vulnerability). OBJECTIVE This research examined the relative contribution of meeting standards and emotional vulnerability barriers to the clinical characteristics of individuals with EDs. METHOD Participants (N = 349) completed the fears of compassion for self-scale, and measures of self-compassion, ED and psychiatric symptom severity, interpersonal and affective functioning, quality of life and readiness for ED change. RESULTS Together, the two barrier types accounted for significant variance in all study variables. Meeting standards was associated with lower readiness to change and greater over-control. In contrast, emotional vulnerability was associated with lower self-compassion, readiness, and quality of life, poorer interpersonal and affective functioning, and greater ED and psychiatric severity. CONCLUSION While both barriers to self-compassion were related to functioning in individuals with EDs, the emotional vulnerability barrier accounted for more variance in pathology and may be most beneficial to target in treatment.
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Affiliation(s)
- Josie Geller
- Eating Disorders Program, Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allison C Kelly
- Department of Psychology, University of Waterloo, Ontario, Canada
| | - Lindsay Samson
- Department of Psychology, York University, Toronto, Canada
| | - Megumi M Iyar
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | - Suja Srikameswaran
- Eating Disorders Program, Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Wang H, Zhao Q, Mu W, Rodriguez M, Qian M, Berger T. The Effect of Shame on Patients With Social Anxiety Disorder in Internet-Based Cognitive Behavioral Therapy: Randomized Controlled Trial. JMIR Ment Health 2020; 7:e15797. [PMID: 32347799 PMCID: PMC7400034 DOI: 10.2196/15797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/22/2019] [Accepted: 02/22/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prior research has demonstrated the efficacy of internet-based cognitive behavioral therapy (ICBT) for social anxiety disorder (SAD). However, it is unclear how shame influences the efficacy of this treatment. OBJECTIVE This study aimed to investigate the role shame played in the ICBT treatment process for participants with SAD. METHODS A total of 104 Chinese participants (73 females; age: mean 24.92, SD 4.59 years) were randomly assigned to self-help ICBT, guided ICBT, or wait list control groups. For the guided ICBT group, half of the participants were assigned to the group at a time due to resource constraints. This led to a time difference among the three groups. Participants were assessed before and immediately after the intervention using the Social Interaction Anxiety Scale (SIAS), Social Phobia Scale (SPS), and Experience of Shame Scale (ESS). RESULTS Participants' social anxiety symptoms (self-help: differences between pre- and posttreatment SIAS=-12.71; Cohen d=1.01; 95% CI 9.08 to 16.32; P<.001 and differences between pre- and posttreatment SPS=11.13; Cohen d=0.89; 95% CI 6.98 to 15.28; P<.001; guided: SIAS=19.45; Cohen d=1.20; 95% CI 14.67 to 24.24; P<.001 and SPS=13.45; Cohen d=0.96; 95% CI 8.26 to 18.64; P<.001) and shame proneness (self-help: differences between pre- and posttreatment ESS=7.34; Cohen d=0.75; 95% CI 3.99 to 10.69; P<.001 and guided: differences between pre- and posttreatment ESS=9.97; Cohen d=0.88; 95% CI 5.36 to 14.57; P<.001) in both the self-help and guided ICBT groups reduced significantly after treatment, with no significant differences between the two intervention groups. Across all the ICBT sessions, the only significant predictors of reductions in shame proneness were the average number of words participants wrote in the exposure module (β=.222; SE 0.175; t96=2.317; P=.02) and gender (β=-.33; SE 0.002; t77=-3.13; P=.002). We also found a mediation effect, wherein reductions in shame fully mediated the relationship between the average number of words participants wrote in the exposure module and reductions in social anxiety symptoms (SIAS: β=-.0049; SE 0.0016; 95% CI -0.0085 to -0.0019 and SPS: β=-.0039; SE 0.0015; 95% CI -0.0075 to -0.0012). CONCLUSIONS The findings of this study suggest that participants' engagement in the exposure module in ICBT alleviates social anxiety symptoms by reducing the levels of shame proneness. Our study provides a new perspective for understanding the role of shame in the treatment of social anxiety. The possible mechanisms of the mediation effect and clinical implications are discussed. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900021952; http://www.chictr.org.cn/showproj.aspx?proj=36977.
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Affiliation(s)
- Haoyu Wang
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China.,School of Psychological and Cognitive Sciences, Beijing Key Laboratory for Behavior and Mental Health, Peking University, Beijing, China
| | - Qingxue Zhao
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Wenting Mu
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Pennsylvania, PA, United States
| | - Marcus Rodriguez
- Department of Psychology, Pitzer College, California, CA, United States
| | - Mingyi Qian
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China.,School of Psychological and Cognitive Sciences, Beijing Key Laboratory for Behavior and Mental Health, Peking University, Beijing, China
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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Fox J, Cattani K, Burlingame GM. Compassion focused therapy in a university counseling and psychological services center: A feasibility trial of a new standardized group manual. Psychother Res 2020; 31:419-431. [PMID: 32584204 DOI: 10.1080/10503307.2020.1783708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objectives: The feasibility and acceptability of a new Compassion Focused Therapy (CFT) group protocol were assessed in a university counseling and psychological services (CAPS) center. Outcome measures included mechanisms of change, compassion, and general psychiatric distress. Method: Eight transdiagnostic CFT groups composed of 75 clients met for 12 weekly sessions. Clients completed measures of fears of compassion, flows of compassion, self-reassurance, self-criticism, shame, and psychiatric distress at pre, mid, and post time points. Self-report feasibility and acceptability data were collected from therapists and clients, respectively. Significant and reliable change was assessed along with exploratory analysis of CFT mechanisms of change using correlational analysis. Results: Significant and reliable change was found for fears of self-compassion, fears of compassion from others, fears of compassion to others, self-compassion, compassion from others, self-reassurance, self-criticism, shame, and psychological distress. Improvements in fears and flows of compassion predicted improvements in self-reassurance, self-criticism, shame, and psychiatric distress. Conclusion: The new CFT group protocol appears to be feasible, acceptable, and effective in a transdiagnostic CAPS population. The identified mechanisms of change support the theory of CFT that transdiagnostic pathological constructs of self-criticism and shame can improve by decreasing fears and increasing flows of compassion.
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Affiliation(s)
- Jenn Fox
- Brigham Young University, Provo, UT, USA
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41
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Efficacy and acceptability of a pilot dietary intervention focusing on self-compassion, goal-setting and self-monitoring. Public Health Nutr 2020; 23:2746-2758. [PMID: 32517844 DOI: 10.1017/s1368980020000658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Overweight and obesity are universal health challenges. Recent evidence emphasises the potential benefits of addressing psychological factors associated with obesity in dietary programmes. This pilot study investigated the efficacy and acceptability of a combined online and face-to-face dietary intervention that used self-compassion, goal-setting and self-monitoring to improve dietary behaviour, as well as psychological factors associated with dietary behaviour. DESIGN Embedded mixed methods including a 4-week before-after trial and a one-on-one interview. Quantitative outcomes of the study were the levels of self-compassion; eating pathology; depression, anxiety and stress; and dietary intake. Qualitative outcomes were participants' perceptions about the acceptability of the intervention. SETTING UNSW Kensington campus. PARTICIPANTS Fourteen participants with overweight and obesity aged between 18 and 55 years old. RESULTS Results showed that the intervention significantly improved self-compassion and some aspects of dietary intake (e.g. decrease in energy intake) at Week Four compared with Week Zero. Some aspects of eating pathology also significantly decreased (e.g. Eating Concern). However, changes in self-compassion over the 4 weeks did not significantly predict Week Four study outcomes, except for level of stress. Most participants found self-compassion, goal-setting and self-monitoring to be essential for dietary behaviour change. However, participants also indicated that an online programme needed to be efficient, simple and interactive. CONCLUSIONS In conclusion, the current study provides preliminary but promising findings of an effective and acceptable combined online and face-to-face intervention that used self-compassion, goal-setting and self-monitoring to improve dietary habits. However, the results need to be examined in future long-term randomised controlled trials.
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Horwood V, Allan S, Goss K, Gilbert P. The development of the Compassion Focused Therapy Therapist Competence Rating Scale. Psychol Psychother 2020; 93:387-407. [PMID: 31021509 DOI: 10.1111/papt.12230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 02/21/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Compassion-focused therapy (CFT) has shown promise as a treatment for a number of clinical presentations; however, existing studies have not adequately addressed issues of treatment fidelity. The aims of the present study were to identify initial candidate items that may be included in a CFT therapist competence rating scale and to develop the behavioural indicators to anchor these items. DESIGN The Delphi method was used to develop and operationalize the competencies required for inclusion in a CFT therapist competence rating scale over five rounds. METHODS Face-to-face meetings with two CFT experts were conducted in rounds one, two, and five, and these were used to define and operationalize the competencies. Nine other CFT experts were invited to complete online surveys in rounds two and four. An 80% consensus level was applied to the online surveys. RESULTS The resulting Compassion Focused Therapy Therapist Competence Rating Scale (CFT-TCRS) consisted of 23 competencies which were separated into 14 'CFT unique competencies' and nine 'Microskills'. There was high agreement about the included 'CFT unique competencies' and 'Microskills'; however, there were some differences in opinion about the specific content of some items. CONCLUSIONS This is the first study that has attempted to reach consensus regarding the competencies and behavioural anchors for a CFT therapist competence rating scale. The next stage of development for the CFT-TCRS is to establish whether the scale can be reliably and validly used to evaluate CFT practice. PRACTITIONER POINTS The Compassion Focused Therapy Therapist Competence Rating Scale (CFT-TCRS) is the first scale to operationalize the unique and generic competencies required to deliver compassion-focused therapy (CFT). The CFT-TCRS can be used as a learning guide for delivering CFT training and with further development could be used to assess therapist competence for CFT training courses, clinical practice, and treatment fidelity in research trials.
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Bardone-Cone AM, Miller AJ, Thompson KA, Walsh EC. Predicting a comprehensive operationalization of eating disorder recovery: Examining self-concept, personality, and negative affect. Int J Eat Disord 2020; 53:987-996. [PMID: 32343432 DOI: 10.1002/eat.23281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Our goal was to examine potential predictors of a comprehensive operationalization of eating disorder recovery, characterized by physical, behavioral, and cognitive recovery, focusing on constructs related to self-concept, personality, and negative affect. METHOD Participants were women with a history of an eating disorder who provided data via survey and interview at two time points separated by about 7-8 years and who met criteria for an eating disorder diagnosis at baseline (N = 36). RESULTS Logistic regression models revealed that self-esteem was a significant predictor of recovery status (OR = 1.12, p = .039) such that individuals with higher self-esteem at baseline demonstrated significantly greater odds of being in full recovery at follow-up. However, when self-esteem was considered in a set along with baseline imposter phenomenon and anxiety, no single construct emerged as a significant unique predictor of recovery in logistic regression analyses. DISCUSSION These results highlight the potential importance of self-esteem in relation to recovery, with clinical implications related to bolstering self-esteem as part of eating disorder treatment. Future research should continue to explore predictors using a comprehensive operationalization of eating disorder recovery in larger, more diverse samples to optimally identify factors associated with achieving recovery.
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Affiliation(s)
- Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine A Thompson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily C Walsh
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Mullen G, Dowling C, Doyle J, O'Reilly G. Experiences of compassion focused therapy in eating disorder recovery: A qualitative model. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Georgina Mullen
- Department of Psychology University College Dublin Dublin Ireland
| | - Clodagh Dowling
- Department of Psychology St Patrick's University Hospital Dublin Ireland
| | - Jillian Doyle
- Department of Psychology St Patrick's University Hospital Dublin Ireland
| | - Gary O'Reilly
- Department of Psychology University College Dublin Dublin Ireland
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Monell E, Clinton D, Birgegård A. Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating. J Eat Disord 2020; 8:17. [PMID: 32377341 PMCID: PMC7193412 DOI: 10.1186/s40337-020-00294-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Emotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed. METHODS This study examined whether the association between emotion dysregulation and ED psychopathology was mediated by different negative self-directed behaviors in 999 ED patients divided into two sub-samples based on absence or presence of objective binge-eating episodes (OBE). Several simple and extended mediation models were examined using the Difficulties in Emotion Regulation Scale (DERS) as independent variable, the Structural Analysis of Social Behavior (SASB) as mediator, and the Eating Disorder Examination Questionnaire (EDE-Q) as dependent variable. RESULTS An associational pathway was found where higher emotion dysregulation was associated with more negative self-directed behaviors, which in turn was associated with higher ED psychopathology. Self-directed behaviors of importance differed between patient groups. In participants without OBE, lower self-love and higher self-attack were influential, whereas in participants with OBE, lower self-affirmation and higher self-blame were influential. CONCLUSIONS Self-directed behaviors may help to explain the association between emotion dysregulation and ED psychopathology. Our findings have both theoretical and clinical implications that are pathology-specific. Addressing specific self-directed behaviors could be an important way of helping patients deal with their emotions in relation to ED psychopathology.
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Affiliation(s)
- Elin Monell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Clinton
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute for Eating Disorders, Oslo, Sweden
| | - Andreas Birgegård
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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46
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Turk F, Waller G. Is self-compassion relevant to the pathology and treatment of eating and body image concerns? A systematic review and meta-analysis. Clin Psychol Rev 2020; 79:101856. [PMID: 32438284 DOI: 10.1016/j.cpr.2020.101856] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 01/09/2023]
Abstract
Eating disorders are severe mental health conditions, with substantial consequences for health and quality of life. Such disorders are strongly associated with body image concerns. It is important to consider treatments that might enhance our ability to treat such cases. Recently, there has been a growing body of research on self-compassion in relation to such problems. However, we are not yet clear about the extent of such effects, given the range of studies and methodologies used. Therefore, a systematic literature review was carried out using four key databases. Meta-analysis was used to reach conclusions about the size of the effects and moderators. Random-effects meta-analyses were conducted with 59 studies. Higher self-compassion was associated with lower eating pathology, reduced body image concerns, and greater positive body image, with medium to strong effect sizes (respectively, r = -0.34, r = -0.45, r = 0.52). Furthermore, self-compassion interventions for eating pathology and body image were effective, and superior to control groups (respectively, g = 0.58, g = 0.39). These findings support the role of self-compassion in understanding and addressing eating and body image concerns. Self-compassion appears to be an adaptive emotion regulation strategy in eating disorders and body image.
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Affiliation(s)
- Fidan Turk
- Department of Psychology, University of Sheffield, Sheffield, UK.
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
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Craig C, Hiskey S, Spector A. Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev Neurother 2020; 20:385-400. [PMID: 32196399 DOI: 10.1080/14737175.2020.1746184] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Compassion focused therapy (CFT) is an increasingly popular therapeutic modality. Its holistic and integrative approach to universal human suffering means that it is well placed as a transdiagnostic therapy. Research into its effectiveness and acceptability has increased over the previous 10 years as the therapy has evolved, and to help consider its status as an evidence-based therapy research concerning its treatment outcomes needs evaluating.Areas covered: This paper reviews research investigating the effectiveness of CFT in clinical populations.Expert opinion: CFT shows promise for a range of mental health problems, especially when delivered in a group format over at least 12 hours. This is important for funding bodies and commissioning groups to consider as they allocate healthcare resources in light of current evidence-based practice. CFT is demonstrably well accepted by clients and clinicians and there is now a clear need for an updated, universally deployed, standard manual to direct future research. This will be critical in enabling widespread implementation and further adoption into mainstream clinical practice, will address the lack of standardization in the current research, and pave the way for further randomized control trials aimed at reducing existing methodological limitations.
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Affiliation(s)
- Catriona Craig
- Buckinghamshire Older People's Psychology Services, The Whiteleaf Centre, Aylesbury, Buckinghamshire, UK, Oxford Health NHS Foundation Trust
| | - Syd Hiskey
- Department of Clinical Psychology, The Oaks Hospital, Colchester, Essex, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology University College London, London, UK
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48
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Coaston SC. Taming the Brain Weasels: Reducing Self-Criticism Through Externalization and Compassion. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2020. [DOI: 10.1080/15401383.2019.1644695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ogden J, Gosling C, Hazelwood M, Atkins E. Exposure to body diversity images as a buffer against the thin-ideal: An experimental study. PSYCHOL HEALTH MED 2020; 25:1165-1178. [DOI: 10.1080/13548506.2020.1734219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jane Ogden
- School of Psychology, University of Surrey, Guildford, UK
| | - Chloe Gosling
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Emily Atkins
- School of Psychology, University of Surrey, Guildford, UK
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Hessler-Kaufmann JB, Heese J, Berking M, Voderholzer U, Diedrich A. Emotion regulation strategies in bulimia nervosa: an experimental investigation of mindfulness, self-compassion, and cognitive restructuring. Borderline Personal Disord Emot Dysregul 2020; 7:13. [PMID: 32637120 PMCID: PMC7333379 DOI: 10.1186/s40479-020-00129-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/10/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While improving emotion regulation (ER) is a central goal in the therapy of bulimia nervosa (BN), there is no experimental evidence on the efficacy of different ER strategies. (1) We hypothesized that mindfulness as well as self-compassion as contextual strategies and cognitive restructuring as classical cognitive behavioral strategy would outperform waiting in improving emotional and eating disorder related outcomes after an unpleasant mood induction. Further, we explored (2) whether contextual strategies outperformed cognitive restructuring and (3) whether comorbid mental disorders and previous treatment for BN influenced the efficacy of contextual ER strategies compared to cognitive restructuring. METHODS Within their first 2 weeks of treatment, inpatients with BN were instructed to utilize mindfulness, self-compassion, and cognitive restructuring or to wait after a pre-induced sadness in a permuted repeated measures design. Patients further rated different emotional and cognitive outcomes on a visual analogue scale at baseline, and before and after each ER strategy. Multiple linear regression analyses were employed to compare (1) the active conditions to waiting, (2) the contextual strategies with cognitive restructuring, and (3) the latter analysis again, but separated according to comorbidity and previous treatment. RESULTS Forty-eight female inpatients with BN (mean age = 26.44 years, SD = 6.64) completed the study. (1) Contextual ER strategies were more efficacious than waiting for eating disorder symptoms. Cognitive restructuring did not differ from waiting for any outcome. (2) Contextual strategies were more efficacious than cognitive restructuring for emotional outcomes. (3) Self-compassion was more efficacious than cognitive restructuring in patients with comorbid mental disorders and previous treatment in increasing control over the present feeling. CONCLUSIONS Contextual strategies, especially self-compassion, seem more efficacious than waiting and cognitive restructuring in improving short-term ER in patients with BN in an experimental setting.
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Affiliation(s)
- Johannes Baltasar Hessler-Kaufmann
- Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Julia Heese
- Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Matthias Berking
- Department of Psychology and Sport Sciences, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Alice Diedrich
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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