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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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Lavi-Rotenberg A, Frishman N, Igra L, Gilboa-Schechtman E, Hasson-Ohayon I. Beyond One's Attitude Toward the Self: The Role of Social Anxiety in Self-Stigma Among Individuals With Schizophrenia. J Nerv Ment Dis 2024; 212:28-32. [PMID: 37846987 DOI: 10.1097/nmd.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
ABSTRACT Self-stigma is associated with a variety of negative self-perceptions among people coping with schizophrenia, as well as with different aspects of social behaviors. We explored the associations between self-compassion, self-esteem, social anxiety, and self-stigma among people coping with schizophrenia. The baseline data of 56 adults with schizophrenia who were enrolled in a Metacognitive Reflection and Insight Therapy trial were used. Participants filled out self-report questionnaires measuring self-compassion, self-esteem, social anxiety, and self-stigma. Self-esteem and self-compassion were negatively correlated with self-stigma and social anxiety. Self-compassion was not found to contribute beyond self-esteem to the prediction of self-stigma. Importantly, self-esteem and social anxiety were found to mediate the effects of self-compassion on self-stigma. Thus, it seems that social variables, in addition to self-variables, may lead to the formation of self-stigma among people with schizophrenia. Therefore, alongside addressing self-esteem and self-compassion, integrating therapeutic elements related to coping with social anxiety into interventions would seem to be an important factor in reducing self-stigma among people with serious mental illness.
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Kurebayashi Y, Sugimoto H. Self-compassion and related factors in severe mental illness: A scoping review. Perspect Psychiatr Care 2022; 58:3044-3061. [PMID: 34988995 DOI: 10.1111/ppc.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To clarify what is known and identify research gaps on the role of self-compassion (SC) and potential interventions for individuals with severe mental illness (SMI). DESIGN AND METHODS We analyzed 24 studies of SC in schizophrenia spectrum disorder, bipolar disorder (BD), and major depressive disorder (MDD). FINDINGS Mindfulness-based cognitive therapy (MBCT) was the most common intervention. Predicting depression by SC was common in MDD and BD; however, relationships between demographics/clinical variables and SC in BD and schizophrenia spectrum disorder remain unclear. PRACTICE IMPLICATIONS MBCT increases SC in SMI. Data regarding predictors of SC are limited, especially in schizophrenia.
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Affiliation(s)
| | - Hiroshi Sugimoto
- Faculty of Nursing, Niigata University of Health and Welfare, Niigata, Japan
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4
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A Psychotherapy Oriented by Compassion and Metacognition for Schizoid Personality Disorder: A Two Cases Series. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Mavituna S, Hahn E, Hahne I, Bergmann N, Pijnenborg M, Ta TMT, Tafelski L, Böge K. Compassion-based approaches: a systematic review of their effectiveness and acceptability in schizophrenia spectrum disorders. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractThe purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.
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Böge K, Pollex F, Bergmann N, Hahne I, Zierhut MM, Mavituna S, Thomas N, Hahn E. Mindfulness, cognitive fusion, and self-compassion in patients with schizophrenia spectrum disorders -A cross-sectional study. Front Psychiatry 2022; 13:959467. [PMID: 35982935 PMCID: PMC9378854 DOI: 10.3389/fpsyt.2022.959467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
In the last decades, third wave approaches in cognitive-behavioral therapies (CBT) have shown effectiveness in treating several mental disorders, including schizophrenia spectrum disorders (SSD). Three crucial processes associated with clinical changes in patients include mindfulness, psychological flexibility (PF) and self-compassion (SC). PF is generally assessed by cognitive fusion (CF), a negative formulated key process of PF. The current study encompasses a cross-sectional design to examine the interplay of mindfulness, CF, SC and symptom severity in SSD. It was hypothesized that mindfulness is negatively correlated with symptom severity, CF mediates the negative relation between mindfulness and symptom severity, and SC moderates the link between mindfulness and CF. In total, 79 persons with SSD were recruited at the Department of Psychiatry and Neurosciences at the Charité - Universitätsmedizin Berlin. Correlations, as well as moderated mediation analyses, were performed using the analysis modeling tool PROCESS with total symptom severity and negative symptom severity as outcome variables, measured by the Positive and Negative Syndrome Scale (PANSS) and the Self-Evaluation of Negative Symptoms Scale (SNS). Results show that the moderated mediation hypothesis was confirmed for negative symptom severity assessed by SNS, however, not for total symptom severity assessed by PANSS. In general, the association between mindfulness and CF was stronger for participants with higher SC scores in our data. Future studies should investigate the relationship between mindfulness, SC, and PF regarding symptom severity in SSD in longitudinal designs while considering the impact on different outcomes and differences regarding assessment tools.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Franziska Pollex
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Niklas Bergmann
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Inge Hahne
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marco Matthäus Zierhut
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Selin Mavituna
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Eric Hahn
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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7
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Carvalho D, Marques CC, Pinto AM, Martins MJ, Leal I, Castilho P. Fears of compassion scales in psychosis: confirmatory factor analysis and psychometric properties. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Steen MP, Di Lemma L, Finnegan A, Wepa D, McGhee S. Self-Compassion and Veteran's Health: A Scoping Review. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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9
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Chio FHN, Mak WWS, Yu BCL. Meta-analytic review on the differential effects of self-compassion components on well-being and psychological distress: The moderating role of dialecticism on self-compassion. Clin Psychol Rev 2021; 85:101986. [PMID: 33667941 DOI: 10.1016/j.cpr.2021.101986] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/18/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022]
Abstract
Although self-compassion has been extensively studied in the recent decades, the representation of self-compassion as a unitary measure or the presence of self-warmth (i.e., presence of the positive components: self-kindness, common humanity, and mindfulness) and self-coldness (i.e., presence of the negative components: self-judgment, isolation, and mindfulness) remains controversial. Moreover, the differential effects of the six components of self-compassion on mental well-being and psychological distress have not been systematically investigated. To synthesize the differential effects of the six components of self-compassion and to examine how people in different cultures may associate the positive and negative components of self-compassion differentially, the present meta-analysis synthesized 183 effect sizes across 27 cultures. Results showed that the negative components of self-compassion (rs = 0.44 to 0.45) showed greater effect sizes with psychological distress than the positive counterparts (rs = -0.17 to -0.29) whereas the positive components of SCS (rs = 0.29 to.39) showed greater effect sizes with mental well-being than the negative counterparts (rs = -0.29 to -0.36), with the exception of common humanity and isolation (r = 0.29 and - 0.36). Cultural orientation of dialecticism moderated the association between the positive and the negative components of self-compassion, with dialectical cultures showing lower associations between the two opposing components. Findings have implications on the design and implementation of self-compassion interventions cross-culturally.
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Affiliation(s)
- Floria H N Chio
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Ben C L Yu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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10
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Hickey T, Nelson B, Meadows G. Application of a mindfulness and compassion‐based approach to the at‐risk mental state. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tara Hickey
- Southern Synergy, Monash University, Melbourne, Victoria, Australia,
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia,
| | - Graham Meadows
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia,
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11
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Brown P, Waite F, Rovira A, Nickless A, Freeman D. Virtual reality clinical-experimental tests of compassion treatment techniques to reduce paranoia. Sci Rep 2020; 10:8547. [PMID: 32444619 PMCID: PMC7244556 DOI: 10.1038/s41598-020-64957-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 12/30/2022] Open
Abstract
Paranoia may build on negative beliefs held both about the self and others. Compassionate imagery may be one way of reducing such negative beliefs, and hence paranoia. Two studies tested this idea, one targeting compassion for the self and one targeting compassion for others. Two-hundred individuals from the general population scoring highly for paranoia were recruited. The studies used a randomised controlled experimental design, with embedded tests for mediation. Study one targeted self-compassion via creation of a compassionate coach (CC) image. Study two targeted compassion for others via loving kindness meditation (LKM). Individuals repeatedly entered neutral virtual reality social environments. Changes in compassion and paranoia were assessed. Compared to controls, the CC group increased in self-compassion (group difference = 2.12, C.I. = 1.57;2.67, p = <0.0001, d = 1.4) and decreased in paranoia (group difference = -1.73, C.I. = -2.48; -0.98, p = <0.0001, d = 0.8). Change in self-compassion explained 57% of change in paranoia. Compared to controls, the LKM group increased their compassion for others (group difference = 3.26, C.I. = 2.72;3.80, p = <0.0001, d = 1.7), and decreased in paranoia (group difference = -1.70, C.I. = -2.50; -0.89, p = <0.0001, d = 0.8). Change in compassion for others explained 67% of change in paranoia. Targeting negative beliefs about the self and others using compassionate imagery causes reductions in paranoia. Tests in clinical populations are indicated.
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Affiliation(s)
- Poppy Brown
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Aitor Rovira
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
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12
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Viou M, Georgaca E. “Enriching Our Inner Dialogue”: An Activity to Explore Compassionate Voices. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2020. [DOI: 10.1080/10720537.2020.1717150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Viou
- School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Hochheiser J, Lundin NB, Lysaker PH. The Independent Relationships of Metacognition, Mindfulness, and Cognitive Insight to Self-Compassion in Schizophrenia. J Nerv Ment Dis 2020; 208:1-6. [PMID: 31738223 PMCID: PMC8106243 DOI: 10.1097/nmd.0000000000001065] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The debilitating nature of psychosis may be exacerbated by societal stigma and feelings of social isolation over and above positive (e.g., hallucinations) and negative (e.g., flat affect) symptoms. Thus, recovery may be facilitated by increasing self-compassion, the ability to respond with a nonjudgmental attitude of kindness toward oneself as a result of connecting with one's own inadequacies and suffering. We conducted a stepwise regression in individuals with schizophrenia-spectrum disorders (n = 92) to determine the unique contributions of cognitive variables in predicting self-compassion, such as metacognition (the ability to form complex and integrated ideas about oneself and others), mindfulness, and cognitive insight. Results indicated that increased metacognitive awareness of others and mindfulness uniquely predicted greater self-compassion (i.e., self-kindness), whereas increased cognitive insight predicted greater lack of self-compassion (i.e., self-judgment). These findings suggest the potential for mindfulness and metacognitive interventions to increase positive self-compassion and promote recovery in psychosis.
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Affiliation(s)
- Jesse Hochheiser
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Nancy B. Lundin
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Paul H. Lysaker
- Department of Psychiatry, Richard L. Roudebush Veterans Affairs Medical Center,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
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Scheunemann J, Schlier B, Ascone L, Lincoln TM. The link between self-compassion and psychotic-like experiences: A matter of distress? Psychol Psychother 2019; 92:523-538. [PMID: 30091175 DOI: 10.1111/papt.12193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Self-shaming and self-criticism have been shown to contribute to the emergence of distressing psychotic symptoms and psychotic-like experiences (PLEs). In contrast, a self-compassionate mindset may protect against negative evaluations in response to PLEs leading to less distress. This study explores the association between self-compassion, the frequency of PLEs, and their associated distress. DESIGN The study used a correlational, cross-sectional design on a German community sample. METHODS A total of 234 participants completed the self-compassion scale (SCS), the Peters' Delusions Inventory, and a modified version of the Launay-Slade Hallucination Scale that measures frequency and distress of hallucinatory experiences. Pearson correlations between SCS and frequency of PLEs as well as between SCS and PLE-distress were compared. Additionally, network analyses of SCS and PLE-measures were calculated. RESULTS Self-compassion was associated with less-frequent PLEs and with less PLE-distress, with stronger correlations between self-compassion and PLE-distress. The network analysis showed the self-compassion facets isolation and overidentification to be the closest links to PLE-distress. CONCLUSIONS Self-compassion is associated with less PLE related distress. Prevention programmes and interventions that target the negative facets associated with lack of self-compassion may be promising. However, future studies need to explore the causal role of self-compassion facets in the formation of PLE-distress. PRACTITIONER POINTS Low levels of self-compassion are associated with being more distressed by psychotic experiences. As the self-compassion facets isolation and overidentification are most strongly related to distress, prevention and intervention programmes may benefit from focusing on these negative facets.
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Affiliation(s)
- Jakob Scheunemann
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Science, Universität Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Science, Universität Hamburg, Germany
| | - Leonie Ascone
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Science, Universität Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Science, Universität Hamburg, Germany
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15
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Martins MJ, Macedo A, Carvalho CB, Pereira AT, Castilho P. Are shame and self‐criticism the path to the pervasive effect of social stress reactivity on social functioning in psychosis? Clin Psychol Psychother 2019; 27:52-60. [DOI: 10.1002/cpp.2406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 09/04/2019] [Accepted: 10/01/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Maria João Martins
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences University of Coimbra Coimbra Portugal
- Department of Psychological Medicine, Faculty of Medicine University of Coimbra Coimbra Portugal
| | - António Macedo
- Department of Psychological Medicine, Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Célia Barreto Carvalho
- Department of Psychology, Faculty of Human and Social Sciences University of Azores Portugal
| | - Ana Telma Pereira
- Department of Psychological Medicine, Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences University of Coimbra Coimbra Portugal
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16
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Vara H, Thimm JC. Associations between self-compassion and complicated grief symptoms in bereaved individuals: An exploratory study. NORDIC PSYCHOLOGY 2019. [DOI: 10.1080/19012276.2019.1684347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Helga Vara
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens C. Thimm
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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17
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Viou M, Georgaca E. Compassionate Voices of Clients and Therapists in Systemic Group Psychotherapy: A Narrative Study. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2019. [DOI: 10.1080/10720537.2019.1679302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Viou
- School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Burke AS, Shapero BG, Pelletier-Baldelli A, Deng WY, Nyer MB, Leathem L, Namey L, Landa C, Cather C, Holt DJ. Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students. Front Psychiatry 2019; 10:1030. [PMID: 32158406 PMCID: PMC7051934 DOI: 10.3389/fpsyt.2019.01030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/30/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Early adulthood represents one period of increased risk for the emergence of a serious mental illness. The college campus provides a unique opportunity to assess and monitor individuals in this at-risk age group. However, there are no validated early detection programs that are widely implemented on college campuses. In an effort to address this gap, we designed and tested an early detection and prevention program tailored to college students. A transdiagnostic approach was employed because of evidence for shared risk factors across major mental illnesses. DESIGN Single arm, prospective study evaluating outcomes following a 4-week intervention. METHOD Three in-person mental health screenings were conducted on the campus of one university. Undergraduate students with at least mildly elevated, self-reported levels of depressive or subclinical psychotic symptoms, who were not receiving treatment for these symptoms, were invited to participate in a 4-session workshop focused on increasing self- and other- awareness and emotion regulation using established mindfulness, self-compassion, and mentalization principles and experiential exercises. Symptoms, resilience-promoting capacities, and aspects of social functioning were assessed pre- and post- intervention. RESULTS 416 students were screened and a total of 63 students participated in the workshop. 91% attended at least 3 of the 4 sessions. The majority of participants found the workshop interesting and useful and would recommend it to a friend. Significant pre-to-post reductions in symptoms (depression, anxiety, and subclinical psychotic symptoms, ps < 0.004) and improvements in resilience-promoting capacities (self-compassion and self-efficacy, ps < 0.006) and indices of social functioning (social motivation, activity, and a measure of comfort with the physical presence of others, ps < 0.04) were observed. Moreover, the significant increases in resilience-promoting capacities correlated with the reductions in affective symptoms (ps < 0.03). CONCLUSIONS These findings suggest that an on-campus mental health screening and early intervention program is feasible, acceptable, and may be associated with improvements in resilience-related capacities and symptom reductions in young adults with non-impairing, subclinical symptoms of psychopathology. Follow-up work will determine whether this program can improve both shorter and longer-term mental health and functional outcomes in this at-risk population.
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Affiliation(s)
- Anne S Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Benjamin G Shapero
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | | | - Wisteria Y Deng
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Maren B Nyer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Logan Leathem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Leah Namey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Carrie Landa
- Behavioral Medicine, Boston University, Boston, MA, United States
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Daphne J Holt
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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19
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Dewsaran-van der Ven C, van Broeckhuysen-Kloth S, Thorsell S, Scholten R, De Gucht V, Geenen R. Self-compassion in somatoform disorder. Psychiatry Res 2018; 262:34-39. [PMID: 29407566 DOI: 10.1016/j.psychres.2017.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/06/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022]
Abstract
'Third wave' cognitive-behavioral therapies have given a boost to the study of resilience factors, such as self-compassion. To get an indication of the potential clinical relevance of self-compassion for somatoform disorder, this study examined whether self-compassion in patients with somatoform disorder is lower than in the general population, and whether self-compassion is associated with number of symptoms and health-related quality of life. Two-hundred-and-thirty-six participants with somatoform disorder and 236 subjects from the general population, matched on sex and age, filled out questionnaires regarding self-compassion (SCS), number of symptoms (PSC) and health-related quality of life (EQ-5D). The difference in self-compassion between the patient group (Mean 3.53, SD .96) and the general population (Mean 4.16, SD .98) was significant with a medium effect size (d = -.65). Multiple regression analyses showed that having a somatoform disorder and low self-compassion were independently associated with number of symptoms and reduced health-related quality of life. The lower level of self-compassion in somatoform disorder and its association with more physical symptoms and lower health-related quality of life, indicate that self-compassion is a potential clinically relevant factor that may influence therapy outcome and that can be a therapeutic target in patients with somatoform disorder.
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Affiliation(s)
- Charlotte Dewsaran-van der Ven
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands; Department of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
| | | | - Shiva Thorsell
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands
| | - Ron Scholten
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands
| | - Véronique De Gucht
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands; Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Rinie Geenen
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands; Department of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
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Dudley J, Eames C, Mulligan J, Fisher N. Mindfulness of voices, self-compassion, and secure attachment in relation to the experience of hearing voices. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 57:1-17. [PMID: 28801978 PMCID: PMC5811822 DOI: 10.1111/bjc.12153] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/05/2017] [Indexed: 12/04/2022]
Abstract
Objectives Developing compassion towards oneself has been linked to improvement in many areas of psychological well‐being, including psychosis. Furthermore, developing a non‐judgemental, accepting way of relating to voices is associated with lower levels of distress for people who hear voices. These factors have also been associated with secure attachment. This study explores associations between the constructs of mindfulness of voices, self‐compassion, and distress from hearing voices and how secure attachment style related to each of these variables. Design Cross‐sectional online. Method One hundred and twenty‐eight people (73% female; Mage = 37.5; 87.5% Caucasian) who currently hear voices completed the Self‐Compassion Scale, Southampton Mindfulness of Voices Questionnaire, Relationships Questionnaire, and Hamilton Programme for Schizophrenia Voices Questionnaire. Results Results showed that mindfulness of voices mediated the relationship between self‐compassion and severity of voices, and self‐compassion mediated the relationship between mindfulness of voices and severity of voices. Self‐compassion and mindfulness of voices were significantly positively correlated with each other and negatively correlated with distress and severity of voices. Conclusion Mindful relation to voices and self‐compassion are associated with reduced distress and severity of voices, which supports the proposed potential benefits of mindful relating to voices and self‐compassion as therapeutic skills for people experiencing distress by voice hearing. Practitioner points Greater self‐compassion and mindfulness of voices were significantly associated with less distress from voices. These findings support theory underlining compassionate mind training. Mindfulness of voices mediated the relationship between self‐compassion and distress from voices, indicating a synergistic relationship between the constructs. Although the current findings do not give a direction of causation, consideration is given to the potential impact of mindful and compassionate approaches to voices.
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Affiliation(s)
- James Dudley
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Catrin Eames
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | | | - Naomi Fisher
- Faculty of Health and Medicine, Lancaster University, Lancashire, UK
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21
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Martins MJ, Castilho P, Carvalho CB, Pereira AT, Carvalho D, Bajouco M, Madeira N, Santos V, Macedo A. Pathways from paranoid conviction to distress: exploring the mediator role of Fears of Compassion in a sample of people with psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1349830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria João Martins
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Célia Barreto Carvalho
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
- Faculty of Human and Social Sciences, Department of Psychology, University of Azores, Ponta Delgada, Portugal
| | - Ana Telma Pereira
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Diana Carvalho
- Faculty of Psychology and Educational Sciences, Cognitive and Behavioural Center for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Miguel Bajouco
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Nuno Madeira
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Vitor Santos
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
| | - António Macedo
- Faculty of Medicine, Department of Psychological Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra University and Hospital Centre, Coimbra, Portugal
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Cognitive insight: A systematic review. Clin Psychol Rev 2017; 55:12-24. [DOI: 10.1016/j.cpr.2017.04.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 03/12/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
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Collett N, Pugh K, Waite F, Freeman D. Negative cognitions about the self in patients with persecutory delusions: An empirical study of self-compassion, self-stigma, schematic beliefs, self-esteem, fear of madness, and suicidal ideation. Psychiatry Res 2016; 239:79-84. [PMID: 27137965 DOI: 10.1016/j.psychres.2016.02.043] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 01/25/2016] [Accepted: 02/17/2016] [Indexed: 11/30/2022]
Abstract
There has been growing awareness of the high prevalence of negative cognitions about the self in patients with persecutory delusions, and it has been proposed that paranoid fears build upon these perceived vulnerabilities. This study aimed to investigate for the first time a wide range of different conceptualisations of the negative self, and to examine associations with suicidal ideation, in patients with persecutory delusions. Twenty-one patients with persecutory delusions and twenty-one non-clinical individuals completed measures relating to negative self cognitions. The delusions group also completed a measure of suicidal ideation. It was found that the patients with persecutory delusions had low self-compassion, low self-esteem, increased fears of being mad, beliefs of inferiority to others, negative self-schemas, and low positive self-schemas when compared to the non-clinical control group. The effect sizes (Cohen's d) were large, and the different conceptualisations of negative self cognitions were highly associated with one another. Self-stigma did not differ between the two groups. Furthermore, suicidal ideation was highly associated with low self-compassion, low self-esteem, fears of madness, and negative self-schema but not self-stigma. This study shows marked negative self cognitions in patients with persecutory delusions. These are likely to prove targets of clinical interventions, with patient preference most likely determining the best conceptualisation of negative self cognitions for clinicians to use.
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Affiliation(s)
- Nicola Collett
- The Oxford Institute of Clinical Psychology Training, University of Oxford, Isis Education Centre, Roosevelt Drive, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Katherine Pugh
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Muris P, Petrocchi N. Protection or Vulnerability? A Meta-Analysis of the Relations Between the Positive and Negative Components of Self-Compassion and Psychopathology. Clin Psychol Psychother 2016; 24:373-383. [DOI: 10.1002/cpp.2005] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/22/2015] [Accepted: 01/04/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Peter Muris
- Maastricht University; The Netherlands
- Virenze-RIAGG; Maastricht The Netherlands
- Stellenbosch University; South Africa
| | - Nicola Petrocchi
- John Cabot University; Rome Italy
- Fondazione Santa Lucia; Rome Italy
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Kennedy A, Ellerby M. A Compassion-Focused Approach to Working With Someone Diagnosed With Schizophrenia. J Clin Psychol 2015; 72:123-31. [PMID: 26662840 DOI: 10.1002/jclp.22251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case report is a shared, compassion-focused therapy account between a therapist and someone with a 20-year history of schizophrenia. It shows the usefulness of compassion in facilitating the courage to address the worst symptoms of psychosis. It does this by promoting a mindfulness of mind and emotional regulation. This approach helped create an alternative position from which to ground and anchor the self so psychotic fears were less able to dominate.
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26
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Waite F, Knight MTD, Lee D. Self-Compassion and Self-Criticism in Recovery in Psychosis: An Interpretative Phenomenological Analysis Study. J Clin Psychol 2015; 71:1201-17. [PMID: 26389845 DOI: 10.1002/jclp.22211] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To increase understanding of the internal processes of recovery in psychosis, with particular consideration given to self-compassion and self-criticism. METHOD Qualitative data were collected by semistructured interviews, from 10 participants with psychosis, and analyzed using interpretative phenomenological analysis. RESULTS Five superordinate themes emerged: (a) "my mind can't take the load": the "curse" of psychosis; (b) the "trap" of self-criticism; (c) "coming to terms" with psychosis in my life to "move on"; (d) "on my own two feet"; and (e) "an opportunity" for growth. The themes included a reciprocal relationship between psychosis and self-criticism, processes of acceptance, empowerment, and posttraumatic growth. CONCLUSIONS The internal process of self-to-self relating contributed to 2 maintenance cycles: self-criticism maintained distressing experiences of psychosis and compassionate self-acceptance resulted in empowered action and promoted recovery and growth. The dual process of acceptance and change in relationship to self was central to recovery.
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Affiliation(s)
- Felicity Waite
- The Oxford Institute of Clinical Psychology Training (OXICPT), Oxford Health NHS Foundation Trust, University of Oxford, Warneford Hospital
| | - Matthew T D Knight
- The Oxford Institute of Clinical Psychology Training (OXICPT), Oxford Health NHS Foundation Trust, University of Oxford, Warneford Hospital.,Berkshire Healthcare NHS Foundation Trust
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Webel AR, Wantland D, Rose CD, Kemppainen J, Holzemer WL, Chen WT, Johnson MO, Nicholas P, Eller LS, Chaiphibalsarisdi P, Sefcik E, Nokes K, Corless IB, Tyer-Viola L, Kirksey K, Voss J, Sullivan K, Rivero-Méndez M, Brion J, Iipinge S, Phillips JC, Portillo C. A Cross-Sectional Relationship Between Social Capital, Self-Compassion, and Perceived HIV Symptoms. J Pain Symptom Manage 2015; 50:59-68. [PMID: 25659523 PMCID: PMC4492802 DOI: 10.1016/j.jpainsymman.2014.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/15/2014] [Accepted: 01/07/2015] [Indexed: 01/28/2023]
Abstract
CONTEXT Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience. OBJECTIVES The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship. METHODS We conducted a cross-sectional analysis of 2182 PLWH at 20 sites in five countries. Social capital, self-compassion, and HIV symptom experience were evaluated using valid and reliable scales. To account for inflated significance associated with a large sample size, we took a random sample of 28% of subjects (n = 615) and conducted correlation analyses and zero-inflated Poisson regression, controlling for known medical and demographic variables impacting HIV symptom experience. RESULTS Controlling for age, sex at birth, year of HIV diagnosis, comorbid health conditions, employment, and income, our model significantly predicted HIV symptom experience (overall model z = 5.77, P < 0.001). Employment status and social capital were consistent, negative, and significant predictors of HIV symptom experience. Self-compassion did not significantly predict HIV symptom experience. For those reporting symptoms, an increase in age was significantly associated with an increase in symptoms. CONCLUSION Employment and social capital modestly predicted current HIV symptom experience. Social capital can be incorporated into symptom management interventions, possibly as a way to reframe a person's symptom appraisal. This may be increasingly important as PLWH age. The relationship between employment status and HIV symptom experience was significant and should be explored further.
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Affiliation(s)
- Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
| | | | - Carol Dawson Rose
- Community Health Systems, University of California School of Nursing at San Francisco, San Francisco, California, USA
| | - Jeanne Kemppainen
- University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | | | - Wei-Ti Chen
- Yale University, New Haven, Connecticut, USA
| | - Mallory O Johnson
- University of California at San Francisco, San Francisco, California, USA
| | - Patrice Nicholas
- Global Health and Academic Partnerships, Brigham and Women's Hospital and Massachusetts General Hospital, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | | | | | | | - Kathleen Nokes
- Hunter College, City University of New York, and Hunter-Bellevue School of Nursing, New York, New York, USA
| | - Inge B Corless
- Global Health and Academic Partnerships, Brigham and Women's Hospital and Massachusetts General Hospital, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Lynda Tyer-Viola
- Global Health and Academic Partnerships, Brigham and Women's Hospital and Massachusetts General Hospital, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Kenn Kirksey
- Center for Nursing Research, Seton Family of Hospitals, Austin, Texas, USA
| | - Joachim Voss
- University of Washington, Seattle, Washington, USA
| | - Kathy Sullivan
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | | | - John Brion
- Ohio State University College of Nursing, Columbus, Ohio, USA
| | | | | | - Carmen Portillo
- Community Health Systems, University of California School of Nursing at San Francisco, San Francisco, California, USA
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