Adolescent Self-Compassion Moderates the Relationship Between Perceived Stress and Internalizing Symptoms

Effects of online mindful self-compassion intervention on negative body image in breast cancer patients: A randomized controlled trail

PURPOSE

The incidence of breast cancer patients with negative body image has increased. However, research on interventions that explicitly reduce negative body image among breast cancer patients remains inadequate. The development of more pragmatic interventions is imperative. Therefore, we conducted this study to assess the effectiveness of a 6-week online Mindful Self-Compassion (MSC) intervention to reduce the negative body image in breast cancer patients.

METHODS

We randomly assigned 64 female breast cancer patients to either the MSC group or the control group. The MSC group received a 6-week online Mindful Self-Compassion intervention, while the control group received no psychological training. Participants were surveyed by the Self-Compassion Scale-Short Form (SCS-SF), the Self-Acceptance Questionnaire (SAQ), the Chinese Perceived Stress Scale (CPSS), and the Body Image Scale (BIS) at baseline (T1), post-intervention (T2), and 1-month follow-up (T3).

RESULTS

All outcome variables demonstrated significant time main effects and nonsignificant group main effects. The MSC and control groups had significant time × group interaction effects on self-compassion, self-acceptance, perceived stress, and negative body image. Simple main effects analysis revealed significant improvements in outcome variables at three-time points for the MSC group.

CONCLUSION

A 6-week online Mindful Self-Compassion intervention can improve self-compassion and self-acceptance and reduce perceived stress and negative body image among the breast cancer patients in MSC group. Mindful Self-Compassion intervention shows promise as a viable way to maintain the mental well-being of breast cancer patients.

Insomnia mediates the relation between empathy and anxiety among nursing students: a latent moderated mediation model of self-compassion

BACKGROUND

Nursing students are faced with multiple challenges and have a higher probability of suffering from anxiety. The current study aims to explore the relation between empathy and anxiety, examining the mediation and moderation effects of insomnia and self-compassion, respectively.

METHODS

This study employed a convenient sampling method, recruiting 1,161 nursing students (female = 923, male = 238, Meanage = 18.37, SDage = 2.38) from three universities in China. These students completed the questionnaires online, including General Anxiety Disorder -7 (GAD-7), Jefferson Scale of Physician Empathy-Nursing student (JSPE-NS), Youth Self-rating Insomnia Scale -8 (YSIS-8), and Self-Compassion Scale (SCS). The study employed latent variable structural equation models to analyze the relation and mechanisms between empathy and anxiety. Then, the mediated role of insomnia and the moderated role of self-compassion were examined.

RESULTS

The prevalence rates of anxiety and insomnia in the current sample are 18.24% and 26.76%, respectively. The results showed that empathy could negatively predict anxiety, with a significant mediating effect of insomnia between them (B = -0.081, p < 0.05, 95% CI [-0.197, -0.063]). Additionally, it was proven that self-compassion moderated the positive relation between insomnia and anxiety. With a higher level of self-compassion, the indirect effect of empathy on anxiety through insomnia was weaker (B = -0.053, p < 0.01, 95% CI [-0.095, -0.019]). When individuals showed a lower level of self-compassion, the indirect effect of empathy on anxiety through insomnia was stronger (B = -0.144, p < 0.01, 95% CI [-0.255, -0.059]).

CONCLUSION

The analysis of this research proved that empathy was negatively related to anxiety, and insomnia served as a mediator between empathy and anxiety. Besides, the protective role of self-compassion on individuals' mental health was identified. The findings of the study suggest that the education of nursing students should highlight the significance of fostering empathy and self-compassion. The intervention on insomnia may be helpful in reducing the levels of anxiety since insomnia is a risky factor for anxiety.

Effects of a Digital Mental Health Intervention on Perceived Stress and Rumination in Adolescents Aged 13 to 17 Years: Randomized Controlled Trial

BACKGROUND

Although adolescents report high levels of stress, they report engaging in few stress management techniques. Consequently, developing effective and targeted programs to help address this transdiagnostic risk factor in adolescence is particularly important. Most stress management programs for adolescents are delivered within schools, and the evidence for these programs is mixed, suggesting a need for alternative options for stress management among adolescents.

OBJECTIVE

The aim of the study is to test the short-term effects of a self-guided digital mental health intervention (DMHI) designed for adolescents on perceived stress and rumination (ie, brooding).

METHODS

This was a 12-week, 2-arm decentralized randomized controlled trial of adolescents aged 13 to 17 years who presented with elevated levels of perceived stress and brooding. Participants were randomly assigned to engage with a self-guided DMHI (Happify for Teens) or to a waitlist control. Participants assigned to the intervention group were given access to the program for 12 weeks. Happify for Teens consists of various evidence-based activities drawn from therapeutic modalities such as cognitive behavioral therapy, positive psychology, and mindfulness, which are then organized into several programs targeting specific areas of concern (eg, Stress Buster 101). Participants in the waitlist control received access to this product for 12 weeks upon completing the study. Participants in both groups completed measures of perceived stress, brooding, optimism, sleep disturbance, and loneliness at baseline, 4 weeks, 8 weeks, and 12 weeks. Changes in outcomes between the intervention and waitlist control groups were assessed using repeated-measures multilevel models.

RESULTS

Of the 303 participants included in data analyses, 132 were assigned to the intervention and 171 to the waitlist. There were significantly greater improvements in the intervention condition for perceived stress (intervention: B=-1.50; 95% CI -1.82 to -1.19; P<.001 and control: B=-0.09; 95% CI -0.44 to 0.26; P=.61), brooding (intervention: B=-0.84; 95% CI -1.00 to -0.68; P<.001 and control: B=-0.30; 95% CI -0.47 to -0.12; P=.001), and loneliness (intervention: B=-0.96; 95% CI -1.2 to -0.73; P<.001 and control: B=-0.38; 95% CI: -0.64 to -0.12; P=.005) over the 12-week study period. Changes in optimism and sleep disturbance were not significantly different across groups (Ps≥.096).

CONCLUSIONS

Happify for Teens was effective at reducing perceived stress, rumination, and loneliness among adolescents over 12 weeks when compared to a waitlist control group. Our data reveal the potential benefits of DMHIs for adolescents, which may present a more scalable, destigmatized, and cost-effective alternative to school-based programs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25545.

Childhood maltreatment and depressed mood in female college students: A daily diary analysis

BACKGROUND

Childhood maltreatment has well-documented relations with depressed mood. However, few studies have used a daily diary methodology to investigate the association between all five forms of childhood maltreatment (emotional, physical, and sexual abuse, emotional and physical neglect) and depressed mood, and the mechanisms underlying the association remain unclear.

OBJECTIVE

The current study sought to examine the associations of multiple forms of childhood maltreatment with depressed mood via a 14-day daily diary methodology, and investigate the mediating effects of self-compassion and perceived social support.

METHODS

A sample of 220 Chinese female college students (Mage = 19.13 years) participated in this study and completed questionnaires regarding childhood maltreatment, self-compassion, perceived social support and depressed mood.

RESULTS

The multilevel regression analysis indicated that only emotional abuse was slightly associated with depressed mood, while emotional neglect, physical abuse, physical neglect, or sexual abuse were not associated with depressed mood. The multilevel mediation analysis further revealed that self-compassion and perceived social support independently mediated the association of childhood emotional abuse with depressed mood.

CONCLUSIONS

Overall, these results emphasize the specific association between childhood emotional abuse and daily depressed mood, and further support self-compassion and perceived social support as explanatory mechanisms linking childhood emotional abuse with later depressed mood.

Self-Compassion and Anxiety in Adolescents with and without Anxiety Disorder

Previous studies have linked self-compassion to mental health, specifically anxiety, in non-clinical adolescents, suggesting that self-compassion can be a protective factor against anxiety. This study compared the overall level of self-compassion and (un)compassionate self-responding in adolescents with and without an anxiety disorder and assessed the association between self-compassion and anxiety. This cross-sectional study included adolescents (12-19 years) with an anxiety disorder (N = 23) and a reference group (N = 28). Participants completed the Self-Compassion Scale (SCS) and State Trait Anxiety Inventory (STAI). Results showed that overall self-compassion and uncompassionate self-responding were significantly lower and higher in the clinical than the reference group, respectively, while compassionate self-responding did not differ between groups. In the clinical group, only uncompassionate self-responding was significantly associated with higher anxiety. In the reference group, uncompassionate self-responding showed a significant positive association with anxiety, and compassionate self-responding showed a significant negative association with anxiety. Although the results suggest that low uncompassionate self-responding may buffer against anxiety, the role of compassionate and uncompassionate self-responding remains unclear. An alternative explanation is that the uncompassionate self-responding items measure the presence of psychopathology in adolescents with an anxiety disorder. More research on the construct validity of the SCS uncompassionate self-responding scale is needed.

The relationship between childhood traumatic experience and suicidal tendency in non-suicidal self-injury behavior patients

BACKGROUND

Individuals with non-suicidal self-injury (NSSI) behavior are usually prone to repeated, intentional, direct harm to their own bodies that is not allowed by society without suicidal ideation. Under this behavior guidance, childhood traumatic experience may easily cause a series of psychological comorbidity symptoms, such as anxiety and depression, finally leading to a suicidal tendency.

METHODS

A total of 311 adolescent NSSI behavioral patients were recruited at the Ningbo Kangning hospital, Zhejiang Province according to the DSM-5 diagnostic criteria. Demographic data, childhood abuse and neglect, internet addiction, self-esteem, anxiety, and suicidal tendency were evaluated. A structural equation model with a path induction mechanism was constructed to evaluate the relationship between distal and proximal factors related to suicidal tendencies due to childhood traumatic experiences in NSSI behavioral individuals.

RESULTS

Among the 311 subjects included in the survey, 250 (80.39%) suffered traumatic experiences, such as emotional abuse/physical abuse/sexual abuse/emotional neglect or physical neglect in their childhood, 303 (97.43%) had suicidal ideation, 271 (87.14%) showed the total score of self-esteem, 148 (47.59%) had different degrees of Internet addiction tendency, and 286 (91.96%) showed obvious anxiety. The established path model fit well (GFI = 0.996, RMSEA = 0.03), and the model showed that self-esteem, anxiety, and childhood traumatic experience had standardized coefficients of -0.235 (z = -4.742, p < 0.01), 0.322 (z = 6.296, p < 0.01), 0.205 (z = 4.047, p < 0.01), respectively, with suicidal ideation path, suggesting that self-esteem, Internet addiction, and anxiety showed significant mediating effects in the process of childhood traumatic experience affecting suicidal ideation.

CONCLUSION

In the context of childhood traumatic experience, it is often accompanied by a series of regulatory behaviors such as Internet addiction, self-esteem, and so on, which finally leads to anxiety, mental symptoms, and even suicidal tendencies. The results provide effective support for the structural equation modeling to evaluate the multi-level influence of NSSI behavior individuals and emphasize that childhood familial factors may lead to psychiatric comorbidity symptoms and suicidal behavior.

Adolescents’ perceived stress of COVID-19 and self-compassion in Saudi Arabia: A cross-sectional study

Objectives

Worldwide, the COVID-19 pandemic has significantly impacted mental health challenges for adolescent populations. The current study aims to examine the levels of perceived stress of COVID-19 and self-compassion and their relationship among adolescents in Saudi Arabia.

Methods

This study employed a cross-sectional online survey of adolescents from secondary schools in Asir, Saudi Arabia. Instruments we distributed online included the modified Perceived Stress Scale (PSS-10) and the Self-Compassion Scale (SCS), in addition to demographic and health-related questions. A total of 500 adolescents completed the survey.

Results

Adolescents in the study reported an average moderate perceived stress level of 18.6 (SD = 6.67) and an average moderate self-compassion level of 3.22 (SD = 0.53). A significant correlation is also found between the two variables (r = −0.460, P < 0.001). This negative correlation indicates that lower levels of perceived stress are significantly correlated with higher levels of self-compassion.

Conclusion

The study results show that the perceived stress of COVID-19 is inversely correlated with self-compassion in Saudi adolescents. Further research is needed to explore how to enhance adolescents' self-compassion. School nurses’ role should be given full play in this area.

The effects of childhood abuse, depression, and self-compassion on adolescent nonsuicidal self-injury: A moderated mediation model

BACKGROUND

Nonsuicidal self-injury (NSSI) is a widespread public health issue in adolescents. Exploring the risk and protective variables of NSSI is critical for prevention and intervention. Based on the experiential avoidance model (Chapman et al., 2006) and Nock's (2009) integrated model of NSSI, the current study tested a moderated mediation model to examine the impact of two risk factors, childhood abuse and depression, and one protective factor, self-compassion, on NSSI.

METHODS

Self-report measures were conducted among 758 Chinese adolescents (329 females and 429 males, mean age = 14.16 years, SD = 1.92) in Hong Kong, China regarding childhood abuse, depression, self-compassion, and NSSI.

RESULTS

Childhood abuse was found to be positively linked to NSSI, and this connection was mediated by depression. Self-compassion weakened the strength between childhood abuse and NSSI, along with that between childhood abuse and depression.

CONCLUSIONS

These results assist in understanding how NSSI develops and facilitate future studies to investigate how the risk and protective variables for NSSI interact. The clinical application of these findings was also discussed.

Psychological maltreatment and adolescent internet harassment perpetration: The mediating role of deviant peer affiliation and the moderating role of self-compassion

BACKGROUND

Psychological maltreatment has been regarded as a risk factor for adolescent internet harassment. However, previous studies failed to take family, peer, and individual factors into account comprehensively when comes to adolescent internet harassment perpetration.

OBJECTIVE

Based on the Social-Ecological Diathesis-Stress Model, the present study established a moderated mediation model to investigate the mediating role of deviant peer affiliation in the association between psychological maltreatment and adolescent internet harassment perpetration, as well as the moderating role of self-compassion.

PARTICIPANTS AND SETTING

A total of 1,592 Chinese adolescents (51.07 % girls, M_age = 13.23 years) participated in the current study.

METHOD

The participants completed questionnaires regarding demographics, psychological maltreatment, internet harassment perpetration, deviant peer affiliation, and self-compassion.

RESULTS

Psychological maltreatment was positively related to adolescent internet harassment perpetration. Mediation analyses revealed that deviant peer affiliation partially mediated this relationship (indirect effect = 0.14, 95 % CI = [0.09, 0.20]). Moderated mediation analyses further indicated that self-compassion not only moderated the link between psychological maltreatment and adolescent internet harassment perpetration, with the effect being significant only for adolescents with low levels of self-compassion, but also moderated the indirect association between psychological maltreatment and internet harassment perpetration via deviant peer affiliation, with the association being much more potent for adolescents with low levels of self-compassion.

CONCLUSIONS

This study highlights the importance of considering multiple circumstantial and individual factors to understand the development of adolescents' externalizing problems.

The relationship between childhood maltreatment and adolescents' cyberbullying victimization: The new phenomenon of a "cycle of victimization"

BACKGROUND

The research community is showing an increasing concern about the adverse outcomes of childhood maltreatment for adolescents. However, whether childhood maltreatment is associated with cyberbullying victimization and what the underlying mechanisms of this relationship are remain to be identified.

OBJECTIVE

We aimed to examine the relationship between childhood maltreatment and cyberbullying victimization and whether self-compassion and fear of missing out (FoMO) can simultaneously moderate this relationship among adolescents.

PARTICIPANTS AND SETTING

A sample of 1025 Chinese adolescents (50.8 % male participants, age = 15.50 ± 0.52 years) completed questionnaires regarding childhood maltreatment, cyberbullying victimization, self-compassion, and FoMO.

METHODS

Our hypotheses were tested by correlation analysis and Model 3 of the PROCESS macro.

RESULTS

Childhood maltreatment significantly predicted adolescents' cyberbullying victimization (β = 0.28, p < .001). High self-compassion weakened the relationship between childhood maltreatment and cyberbullying victimization (β = -0.10, p < .001). Furthermore, self-compassion and FoMO simultaneously interacted with childhood maltreatment to predict cyberbullying victimization (β = 0.08, p < .001). Specifically, high FoMO weakened the moderating effect of self-compassion on the relationship between childhood maltreatment and cyberbullying victimization. Childhood maltreatment significantly predicted cyberbullying victimization among adolescents high in FoMO, regardless of self-compassion levels. In contrast, childhood maltreatment non-significantly predicted cyberbullying victimization when adolescents were high in self-compassion and low in FoMO.

CONCLUSIONS

Childhood maltreatment is positively associated with cyberbullying victimization. Moreover, increasing self-compassion and decreasing FoMO can mitigate the effect of childhood maltreatment on cyberbullying victimization.

The relationship between perceived stress and depressive symptoms in adolescents during high stress: The moderating role of emotion regulation

INTRODUCTION

This study examined the moderating role of adaptive and maladaptive emotion regulation in the relationship between general perceived stress and depressive symptoms during the first coronavirus disease 2019 (COVID-19) lockdown in March-April 2020 in Belgium, while controlling for past depressive symptoms in 2016.

METHODS

Participants were 110 adolescents (55% female; Mage = 16, SDage = 1.80) who filled out different questionnaires assessing maladaptive and adaptive emotion regulation strategies (ERS), perceived stress, and depressive symptoms.

RESULTS

Results revealed that only maladaptive ERS statistically significantly moderated the relationship between perceived stress and depressive symptoms. More specifically, the amount of perceived stress is positively associated with the level of depressive symptoms, especially in adolescents who use more maladaptive ERS.

CONCLUSION

The repertoire of adaptive ERS might not be sufficient for adolescents to flexibly cope with a highly stressful situation such as the COVID-19 pandemic and lockdown. Study findings highlight the need to support youth, particularly those who use more maladaptive ERS, in adaptively coping with intense stressful life events.

Developing a novel co-produced methodology to understand 'real-world' help-seeking in online peer-peer communities by young people experiencing emotional abuse and neglect

BACKGROUND

Recent systematic reviews suggest mediating factors (barriers and facilitators) of help-seeking for children and young people (CYP) with a range of mental health problems but highlight the need for a more robust methodology underpinned by theoretical frameworks. Emotional abuse and neglect is the most prevalent and pervasive form of abuse, with many CYP remaining unknown to professional services. These CYP are underrepresented in help-seeking research yet seek help from their peers via anonymous online publicly available message communities.

OBJECTIVES

To sensitively co-develop qualitative methodology to explore 'real-world' data to inform our understanding of help-seeking for these CYP, and define potential mediators (barriers and facilitators) and mechanisms of change associated with online peer support.

METHODS

Co-production with 10 young co-researchers (YCoR; aged 14-18 years) from the NeurOX Young People's Advisory Group (YPAG) included co-development and triangulation to apply different research methods (i.e., interpretative phenomenological, thematic and conversation analyses) to analyse rich ethnographic material from 20 publicly available online message conversations between help-seekers experiencing or questioning emotional abuse and neglect. A theoretical model of adolescent help-seeking proposed by Rickwood et al. was used as a conceptual framework to guide methodological development.

RESULTS

The methodological approach facilitated the identification of barriers and facilitators of help-seeking contextualized to the lives of these CYP: understanding and validating of abuse, emotional competence, fears and uncertainties around disclosure, knowledge, motivational factors and connection/trusted relationships. Notably, positive changes in expressed or perceived 'psychological state' and/or intention to seek help were noticed in 9 of 10 message threads that included a 'conversation' (≥3 posts). Themes associated with change related to connection with supportive peers; compassionate responding and the safeness of the online community. The existing adolescent help-seeking model was found to be too simplistic to account for help-seeking associated with emotional abuse and neglect.

CONCLUSION

The novel methodological approach offers a meaningful way to explore 'real-world' data with YCoR, for a population underrepresented in help-seeking research. Proposed relational mechanisms involve connection, compassion and online communities. Further research coproduced with YCoR with diverse care experiences and characteristics is required to upscale the methodology and further validate and extend the findings.

PUBLIC CONTRIBUTION

The core study was co-produced with 10 YCoRs from the NeurOX YPAG who have been involved in over 135 h on and offline work. Their roles involved co-deciding the direction of the study, evolving methodology, detailed co-analysis and reflective processes throughout all aspects of the study, interpretation, presentation and discussion of the findings with the NSPCC and Childline, and involvement in all communications. Additional consultation and involvement included further interested members of the NeurOX YPAG for the final online workshop and dissemination outputs.

Depressive Symptoms, Perceived Stress, Self-Compassion and Nonsuicidal Self-Injury Among Emerging Adults: An Examination of the Between and Within-Person Associations Over Time

Many emerging adults report experiencing mental health challenges (e.g., depressive symptoms and perceived stress) during the transition to university. These mental health challenges often coincide with increased engagement in nonsuicidal self-injury (NSSI; e.g., self-cutting or burning without lethal intent), but longitudinal research exploring the nature of the associations among depressive symptoms, perceived stress, and NSSI are lacking. In the present study, it was examined whether depressive symptoms and perceived stress predicted increased risk for NSSI over time (or the reverse), and whether these effects were mediated or moderated by self-compassion. The sample consisted of 1,125 university students (Mage = 17.96 years, 74% female), who completed an online survey three times in first year university. A random intercept cross-lagged panel model revealed that higher depressive symptoms, perceived stress, NSSI, and lower self-compassion often co-occurred, but only NSSI predicted increased perceived stress over time. Theoretical and practical implications are discussed.

Gender differences in self-compassion: a latent profile analysis of compassionate and uncompassionate self-relating in a large adolescent sample

Self-compassion, a healthy way of relating to oneself, may promote psychological resilience during adolescence. How adolescents engage with self-compassion, and whether they have distinct self-compassionate or uncompassionate psychological profiles, is unclear. This study investigated potential self-compassion profiles based on responses to the Self-Compassion Scale–Short Form (SCS-SF) and examined their relationship with a range of mental health symptoms and cognitive and emotional tendencies. A large cross-sectional sample of high school students (N = 950; Mage = 13.70 years, SDage = 0.72, range = 12 to 16 years; 434 female and 495 male) completed several online self-report measures including the SCS-SF. Latent profile analysis identified parsimonious self-compassion profiles by gender using the six SCS-SF subscales. Five female profiles included ‘Low Self-Relating’, ‘Uncompassionate’, ‘High Self-Relating’, ‘Moderately Compassionate’ and ‘Highly Compassionate’. Comparatively, two male profiles included ‘Low Self-Relating’ and ‘Moderately Self-Relating’. Low Self-Relating involved low levels of both compassionate and uncompassionate responding, and Moderately Self-Relating involved higher levels of both. Low Self-Relating and Highly Compassionate profiles for females consistently reported lower levels of anxiety and depression symptoms, maladaptive perfectionism, intolerance of uncertainty, repetitive thinking and avoidance-fusion thinking patterns compared to the other female profiles. Low Self-Relating males reported more adaptive outcomes compared to Moderate Self-Relating males. These findings illustrate important adolescent gender differences in compassionate and uncompassionate self-response profiles. Results suggest self-compassion is an important psychological construct with diverse mental health benefits for females, whereas for males a lack of attachment to either response styles are linked with better psychological outcomes.

Slow-Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot

Purpose

Nearly one in three US adolescents meet the criteria for anxiety, an issue that has worsened with the COVID-19 pandemic. We developed a video-based slow diaphragmatic breathing stress-reduction curriculum for high school students and evaluated its feasibility, tolerability, and preliminary effectiveness.

Methods

This cluster-randomized feasibility pilot compared 5-min slow diaphragmatic breathing for 5 weeks with treatment-as-usual control among four 12th-grade public high school classes. Students individually participated after school during COVID-19-related hybrid teaching, with slow diaphragmatic breathing three times/week and breath science education once/week. Feasibility was based on completion of breathing exercises, breath science education, and preliminary effectiveness assessments, and ease/tolerability was based on qualitative assessments. Preliminary effectiveness was measured with the State-Trait Anxiety Inventory (STAI) and a timed-exhale carbon dioxide tolerance test (CO₂TT) of physiological stress response. Descriptive statistics and repeated analysis of variance were performed to quantify and compare outcomes between time periods. Human subjects research approval was granted through Western IRB–Copernicus Group (WCG IRB) [ClinicalTrials.gov, Identifier: NCT05266833.]

Results

Forty-three students consented to participate. Breath practice compliance ranged from 29 to 83% across classes and weeks, and decreased on average over the 5 weeks. Compliance with the breath science videos ranged from 43 to 86%, and that with the weekly STAI-State and CO₂TT measures varied from 36 to 86%. Compliance with ease/tolerability assessments ranged from 0 to 60%. Preliminary effectiveness assessments' compliance varied across classes from 83 to 89% during baseline, and 29 to 72% at follow-up. The curriculum was rated as somewhat-to-definitely useful/beneficial, and definitely-to-very easy/tolerable. Students reported enjoying the diaphragmatic breathing, CO₂TT, and breath science education; some found the extended exhales challenging and the curriculum and assessments time-consuming. Preliminary effectiveness analyses indicated no significant changes in STAI or CO₂TT from baseline to followup or from before to after breathing exercises (p > 0.05 for all).

Conclusions

Implementation of this 5-week slow breathing curriculum was feasible and tolerable to this cohort. Compliance, tolerability, and effectiveness may be improved with in-class participation. Future research on simple and accessible slow-breathing exercises is warranted to address today's adolescent stress-management crisis.

Trial Registration

ClinicalTrials.gov, Identifier: NCT05266833

A Review of Self-Compassion as an Active Ingredient in the Prevention and Treatment of Anxiety and Depression in Young People

Previous meta-analyses have found higher self-compassion is associated with lower anxiety and depression. The aim of this study was to investigate the efficacy of self-compassion as an active ingredient in the treatment and prevention of anxiety and depression in youth. This was conducted through (i) a systematic review of the literature and (ii) qualitative consultation with young people and researchers in self-compassion. Fifty studies met our inclusion criteria. Eight studies evaluated self-compassion interventions among youth aged 14-24, and the remaining studies measured the association between self-compassion and anxiety, and/or depression among this age group. Qualitative interviews were conducted with four self-compassion researchers. Interviews were also conducted in two rounds of consultation with 20 young people (M age = 18.85 years, age range 14-24 years). Higher self-compassion was related to lower symptoms of anxiety, r =  - 0.49, 95% CI (- 0.57, - 0.42), and depression, r =  - 0.50, 95% CI (- 0.53, - 0.47). There was evidence for self-compassion interventions in decreasing anxiety and depression in young people. Consultation with young people indicated they were interested in self-compassion interventions; however, treatment should be available in a range of formats and tailored to address diversity. Self-compassion experts emphasised the importance of decreasing self-criticism as a reason why self-compassion interventions work. The importance of targeting self-criticism is supported by the preferences of young people who said they would be more likely to engage in a treatment reducing self-criticism than increasing self-kindness. Future research is required to add to the emerging evidence for self-compassion interventions decreasing symptoms of anxiety and depression in young people.

Psychometric Validation of the Persian Self-Compassion Scale Youth Version

Objectives

Empirical research investigating self-compassion is a rapidly developing field, and it is potentially crucial in early adolescence. The primary aim of the present study was to psychometrically evaluate the Persian translation of the Self-Compassion Scale Youth version (SCS-Y) and evaluate its factor structure among young adolescents. The second aim was to explore the buffering effect of self-compassion against the negative effect of difficulties in emotion regulation on COVID-19-related anxiety.

Methods

A sample of young students (n = 532; mean age 13.57 years) completed an online survey, which included the SCS-Y, Patient Health Questionnaire, Difficulties In Emotion Regulation Scale, Coronavirus Anxiety Scale, Youth Life Orientation Test, Brief Resilience Scale, and Brief 10-Item Big Five Inventory. First-order (six-factor) confirmatory factor analysis (CFA) and bi-factor exploratory structural equation modeling (ESEM) analysis were used to evaluate the factor structure of the SCS-Y.

Results

Results showed that the SCS-Y had very good internal consistency (Cronbach's alpha coefficient: 0.88; McDonald's omega coefficient: 0.90), composite reliability (0.87), and adequate test-retest reliability after 4 weeks (0.60). The first-order (six-factor) CFA and bi-factor ESEM analysis demonstrated the SCS-Y had excellent dimensionality. Further analysis found negative associations between self-compassion with both depression and neuroticism, and positive associations between self-compassion with both resilience and optimism. Moreover, self-compassion moderated the association between emotion dysregulation and anxiety generated by the COVID-19. Overall, the findings indicated that the SCS-Y had acceptable criterion-related validity, convergent validity, and discriminant validity.

Conclusions

The findings provide evidence that the SCS-Y is a reliable and valid instrument for assessing the six factors of self-compassion among younger adolescents. Based on the study's findings, self-compassion appears to be a protective factor against mental health problems during the COVID-19 pandemic for younger adolescents.

Relationship between stressful life events and cyberbullying perpetration: Roles of fatalism and self-compassion

Few studies have documented the relationship between stressful life events and cyberbullying perpetration, and the mechanisms connecting this link are unknown. Thus, the current study tested the association of stressful life events with cyberbullying perpetration and explored this influencing mechanism further with fatalism and self-compassion tested as a mediator and a moderator respectively. A sample of 1104 Chinese adolescents (50.72% males; mean age = 13.11) volunteered for this study. The results revealed that exposure to stressful life events was positively related to cyberbullying perpetration, and fatalism played a mediation role in this relationship. The moderated mediation model revealed that stronger self-compassion weakened and even interrupted the direct associations of stressful life events with fatalism and cyberbullying perpetration, and further weakened and even interrupted the indirect relationship between stressful life events and cyberbullying perpetration via fatalism. That is, adolescents low in self-compassion were more likely to build fatalistic beliefs and engage in cyberbullying perpetration when they experienced high levels of stressful life events; whereas, stressful life events were not related to increased risk of cyberbullying perpetration among adolescents high in self-compassion.

Perceived stress of the COVID-19 pandemic and adolescents' depression symptoms: The moderating role of character strengths

The outbreak of COVID-19 could increase adolescents' psychological distress and have a detrimental effect on their mental health. However, the negative effect of the COVID-19 pandemic on adolescents' mental health might be moderated by their existing psychological resources. The present study sought to investigate whether the relationship between adolescents' perceived stress of the COVID-19 pandemic and their depression symptoms was alleviated by their character strengths. A total of 617 adolescents were recruited and completed the online survey during the COVID-19 pandemic. The results indicated that adolescents' perceived stress of the COVID-19 pandemic was significantly positively correlated with their depression symptoms. Character strengths were significantly negatively correlated with adolescents' perceived stress of the COVID-19 pandemic and their depression symptoms. Moreover, the moderating effect of character strengths on the relationship between adolescents' perceived stress of the COVID-19 pandemic and their depression symptoms was significant. Therefore, adolescents' character strengths as a protective factor could buffer the effect of perceived stress of the COVID-19 pandemic on their depression symptoms and contribute to maintaining their mental health.

Perceived stress, self-compassion and job burnout in nurses: the moderating role of self-compassion

BACKGROUND

Job burnout is more prevalent among nurses than other medical team members and may have adverse effects on the mental and physical health of both nurses and their patients.

AIMS

To evaluate the associations between job burnout as a dependent variable with perceived stress and self-compassion as independent variables, and test the buffering role of self-compassion in the link between perceived stress and job burnout in nurses.

METHODS

This is a cross-sectional study with a convenience sampling method. A total of 150 nurses from four hospitals in Tehran, Iran participated in this study and completed three questionnaires, namely the Perceived Stress Scale, the Self-Compassion Scale and the Copenhagen Burnout Inventory.

RESULTS

Partial least square-structural equation modelling showed greater levels of perceived stress associated with greater levels of job burnout (β = 0.795, p < 0.001), and greater levels of self-compassion associated with lower levels of job burnout (β = -0.512, p < 0.001) in nurses. The results of the interaction-moderation analysis showed that self-compassion diminished the effect of perceived stress on job burnout in nurses.

CONCLUSIONS

The results of this study not only showed a significant association between perceived stress and job burnout in nurses, but also increased our understanding about the buffering role of self-compassion in the link between perceived stress and job burnout in nurses.

Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial

Background

Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress.

Objective

The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination.

Methods

This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions.

Results

Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021.

Conclusions

Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally.

Trial Registration

ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888

International Registered Report Identifier (IRRID)

PRR1-10.2196/25545

The mediating role of self-compassion between proactive coping and perceived stress among students

Proactive coping has been documented as a significant predictor of perceived stress. When facing stressful events, the more individuals use proactive coping strategies, the lower their stress level will be. However, there is still little research of possible latent factors participating in this relationship to explain how proactive coping can reduce of perceived stress, directly and indirectly. This study aimed to examine whether self-compassion can mediate the relationship between proactive coping and perceived stress among students. In a cross-sectional study carried out in 2019, we invited 384 undergraduate students in Hanoi (Vietnam) to voluntarily complete a self-report questionnaire that measured proactive coping, self-compassion and perceived stress scale. Results showed that proactive coping was positively related to level of self-compassion, and both proactive coping and self-compassion were negatively related to stress scores. The effect of proactive coping on stress was eliminated when self-compassion was controlled, showing the mediating role of self-compassion in the relationship between proactive coping and perceived stress score. Furthermore, among six factors contributing to the concept of self-compassion, data documented mediating role of "self-kindness,""self-judgment," and "mindfulness" while no mediating role of "common humanity,""isolation," and "over-identification" was observed. Among three mediating factors, mindfulness appeared to be the most important factor explaining the relationship between proactive coping and perceived stress. These results consolidate existing literature of the protective role of self-compassion on psychological health, and hence provide more support for the application of self-compassion, especially of mindfulness, in working with people with stress.

Mindful BALANCE (breathe act learn about 'now' care everyday): A pilot project for depressed female adolescents

PROBLEM

Major depressive episodes in adolescent females have increased during the past decade, placing them at risk to engage in unhealthy lifestyle behaviors, unsafe thoughts, suicidal ideation, and lethal actions. Mindfulness, a tool for stress management, is underutilized.

METHODS

Mindful BALANCE (Breathe Act Learn About 'Now' Care Everyday), a group therapy pilot program introduced a variety of mindfulness activities. The extended mindfulness followed the Creating Opportunities for Personal Empowerment (COPE), a Cognitive Behavioral Therapy Skills Building (CBSB) Healthy Lifestyle program. The pilot program was offered in an outpatient mental health department for 7 weeks.

FINDINGS

Mindful BALANCE is a feasible program as an adjunct to individualized psychotherapy. Six subjects engaged without absence with a completion rate of 83%. Six subjects had pre- and post-scores for depression and anxiety decrease. Mindfulness practice was reported to decrease the perception of stress.

CONCLUSION

Mindful BALANCE decreased perceived depression and anxiety symptoms while positively impacting healthy activities in adolescent females. Further research is necessary to readdress feasibility and extended mindfulness components in improving global well-being and diminishing suicide risk.