Self-compassion training for binge eating disorder: a pilot randomized controlled trial

Protecting young women's body image from appearance-based social media exposure: A comparative study of self-compassion writing and mindful breathing interventions

OBJECTIVE

This study compared the effectiveness of self-compassion writing and mindful breathing in protecting body image after exposure to appearance-focused social media. It focused on individuals with high self-objectification and explored the underlying mechanisms and emotional benefits of these interventions.

METHODS

A randomized controlled trial was conducted with 107 young females (17-25 years) assigned to self-compassion writing (n = 37), mindful breathing (n = 36), or control (n = 34) groups. Body dissatisfaction was induced using idealized body imagery, after which participants completed their respective interventions. State body image was measured at baseline, post-induction, and post-intervention. At the end of the study, a semi-structured interview was conducted, and the data were analyzed using Neff's self-compassion framework.

RESULTS

A two-way ANOVA revealed a significant interaction effect between group and time point F (3.98, 207.15) = 8.45, p < 0.001, partial η2 = 0.140. Self-compassion writing through enhanced self-kindness improved state body image beyond baseline levels. Trait self-objectification moderated the efficacy of the intervention (∆R2 = 0.04, F (2,100) = 3.48, p = 0.035). Mediation analysis revealed that both interventions improved emotional state through body image enhancement (mediation effect size = 0.21).

CONCLUSIONS

Self-compassion writing demonstrated superior efficacy over mindful breathing, primarily through fostering self-kindness. Body image emerged as a critical mediator of emotion improvement, highlighting the value of mindfulness-based interventions in promoting body positivity and emotional resilience following appearance-based social media exposure.

eBEfree: Combining Psychoeducation, Mindfulness, and Self-Compassion in an App-Based Psychological Intervention to Manage Binge-Eating Symptoms: A Randomized Controlled Trial

OBJECTIVE

To develop and test the effectiveness of the eBEfree program, a 12-session app-based version of a previously tested psychological intervention (BEfree) that combines psycho-education, self-compassion, mindfulness, and Acceptance and Commitment Therapy to reduce binge-eating symptoms.

METHOD

Two-hundred participants with recurrent elevated binge-eating symptoms and a higher body weight were enrolled in a remote parallel-group randomized trial, of which 142 completed the initial assessment (70 in the intervention group). The end-of-treatment and follow-up assessments were conducted 12 weeks after the initial assessment and 26 weeks after the end of treatment, respectively. Intention-to-treat (ITT) analyzes were undertaken using frequentist linear mixed models and Bayesian hierarchical models to test the intervention effectiveness.

RESULTS

43 (waitlist control) and 29 (intervention) participants completed the end-of-treatment assessment, showing a high attrition rate (51%). ITT analyzes showed the eBEfree program to be associated with a significant reduction in binge eating symptomatology from baseline to end-of-treatment (β = -9.49, ρ < 0.0001, g = -1.17), and from end-of-treatment to 26-weeks follow-up (β = -6.01, ρ = 0.04, g = -1.08). At end-of-treatment, the intervention was also associated with a decrease in body mass index and depression symptomatology, as well as an improvement in dimensions of self-criticism and mindfulness. More than 80% of participants rated the quality of the program as positive and helpful.

DISCUSSION

This trial suggests potential benefits of the eBEfree program to help individuals manage symptoms of binge-eating more effectively, reduce weight, and improve well-being and mental health. The intervention benefits should be confirmed in future larger trials.

PUBLIC SIGNIFICANCE

Treating binge-eating (BE) symptoms and associated comorbidities might be challenging for mental health services. Digital and app-based interventions can be a valuable resource to help people manage symptoms and improve well-being and mental health. The current trial suggests the potential benefits of an app-based intervention (eBEfree program) to help people reduce BE symptoms and develop psychological strategies to promote well-being and mental health.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT04101032 ("eBEfree-an ICT Adaptation of BEfree").

Gender and Racial Differences in the Overvaluation of Shape, Weight, Excess Skin, and Psychosocial Correlates Following Bariatric Surgery

BACKGROUND

Overvaluation of shape and weight (OSW) is a risk factor for psychopathology in those who have undergone bariatric surgery, and overvaluation of excess skin (OES) may present similar psychological risks. Identifying potential gender and racial differences in post-surgical OSW and OES, and their associations with psychosocial outcomes, may inform more individualized assessment and treatment for those who have undergone bariatric surgery.

METHODS

In this cross-sectional study, individuals up to 4 years post-bariatric surgery completed an online survey of various psychosocial outcomes. Overvaluation was examined via the shape and weight overvaluation subscale of the Eating Disorders Examination Questionnaire (EDE-Q), and a modified item was used to assess the overvaluation of excess skin. Quality of life (QOL), depression, and anxiety symptoms were also examined. Gender and racial differences in OSW and OES were examined. Correlations were obtained between OSW/OES, QOL, and psychological symptoms among gender and racial groups.

RESULTS

Of 735 participants, women endorsed significantly greater OES than men (p = .008). There were no significant gender differences in OSW. White patients endorsed greater OSW than Black patients (p < .001), and there were no racial differences in OES. OSW and OES were inversely correlated with QOL among all groups. OSW and OES were positively associated with anxiety and depressive symptoms among both racial groups and women.

CONCLUSION

Women may be at greater risk for OES than men, while White patients may be at increased risk for OSW. However, OSW/OES related to poorer QOL in all groups, and greater psychological symptoms in women.

Does Self-Compassion Expressive Writing Benefit People With an Ostomy? A Randomized Controlled Trial

PURPOSE

The purpose of this study was to investigate whether a self-compassion expressive writing activity could improve psychological well-being in people with an ostomy, as assessed by changes in body image distress, ostomy-specific quality of life (QOL), self-compassion, and dispositional disgust.

DESIGN

Randomized controlled trial design was used.

SUBJECTS AND SETTING

The sample comprised 175 English-speaking patients over 18 years of age with a fecal or urinary ostomy; all participants resided in Australia and New Zealand. All were recruited online between May and July 2019.

METHODS

Following completion of a baseline questionnaire, participants were randomly assigned to complete either an online self-compassion expressive writing exercise (intervention group; n = 88; 50.29%) or a control expressive writing exercise (n = 87; 49.71%). Online questionnaires were completed 1-week and 1-month following completion of either expressive writing task. Intent-to-treat repeated-measure ANOVA analyses assessed benefits to self-compassion, body image distress, and ostomy-specific quality of life. Dispositional disgust sensitivity and propensity, as assessed by baseline scores on the Dispositional Disgust Sensitivity and Propensity Scale (DPSS), were assessed as moderators.

RESULTS

Analyses revealed that younger people with an ostomy had poorer self-compassion, greater body image distress, and poorer ostomy-specific QOL than older people, and those who had lived with their ostomy for longer had lower body image distress and greater QOL. There were no significant main effects of writing condition on primary measures; however, individuals in the intervention condition with low dispositional disgust had greater self-compassion, greater ostomy-specific QOL, and lower body image distress than those with high dispositional disgust.

CONCLUSION

Although expressive writing is a pragmatic and accessible intervention, our findings suggested that it was of benefit only to people with low dispositional disgust. Further work is required to establish an effective psychological tool for this under-researched population.

From fixing to connecting: parents' experiences supporting adult children with eating disorders

BACKGROUND

Unlike evidence-based guidelines that exist for families of youth with eating disorders, little is known about the optimal role for families of adult patients. Given issues of patient autonomy and confidentiality, it is common for family members to report high levels of distress, confusion about how to offer support, and feelings of exclusion. Nevertheless, interactions with parents play a critical role in the recovery process. The purpose of this research was to increase understanding of support experiences of parents of adult children while identifying what they believe to be the most beneficial forms of support.

METHODS

Sixteen parents of adults who were either recovered or actively engaged in intensive eating disorders treatment participated in semi-structured interviews. Participants were asked to describe the nature of their relationship, beliefs about their child's support needs, and factors that challenged or facilitated their capacity to offer what they deemed as optimal support.

RESULTS

In the context of receiving support and practicing self-care, parents' aspiration shifted from fixing the eating disorder to prioritizing a relational goal of unrelenting connection with their child. Achieving this involved three key skills: managing reactions and expectations, learning boundaries, and practicing validation.

CONCLUSIONS

This research highlights the ongoing challenges faced by parents, indicating that interventions aimed at supporting their own well-being and fostering connection with their child may be of benefit.

Addressing Shame Through Self Compassion

Shame is a common experience for individuals living with chronic diseases related to lifestyle, such as obesity and diabetes. It is often characterized by feelings of stigma and worthlessness, leading many patients to feel judged and unworthy of respect, which can profoundly affect health outcomes and overall quality of life. Despite the severe consequences of shame, therapeutic approaches to address it remain underexplored. This paper highlights the role of Acceptance and Commitment Therapy and Compassion Focused Therapy as effective strategies to mitigate shame, cultivate self-compassion, and, therefore, enhance health outcomes for individuals with chronic lifestyle-related conditions. These therapies have demonstrated positive effects on treatment adherence and self-management among patients with chronic diseases. Therefore, healthcare providers can improve patients' overall well-being by adopting strategies from these therapies, such as using compassionate language that emphasizes empathy, non-judgmental support, and validation, all of which help reduce shame and stigma.

"I feel so small and big at the same time"-exploring body experience and binge eating disorder following inpatient treatment: a qualitative study

Background

Limited research into binge eating disorder (BED), a low treatment rate, and a lack of treatment rights, reflects a marginalized disorder in society and a treatment context.

Aim

The aim of this study was to gain a deeper understanding of the psychopathology of BED, by exploring the patients' meanings related to the disorder and the role of the body in the treatment of BED.

Method

Qualitative methodology using a reflexive thematic analysis. The data material is based on semi-structured in-depth interviews with six cis-gendered women who had previously completed an inpatient treatment program for BED at a department for EDs and met the criteria for 307.51 Binge Eating Disorder in DSM-5.

Results

The qualitative analysis rendered two meta-themes comprising six themes and 12 subthemes. The initial meta-theme was "Relational challenges and feelings could not be talked about at home." The secondary meta-theme was "Body contempt disturbs the experience of self and others" and the third was "Their body has not been a theme in previous treatment." This categorization depicts a narrative of the disorder in terms of development, current condition, and experiences with prior treatment.

Discussion

The findings indicate that shame and disgust are central to playing pivotal roles in the embodiment of BED, highlighting the significance of addressing one's relationship with their body for achieving recovery and preventing an experienced repetition of the perceived rejection as a child.

A pilot study of an online self-compassion intervention for adults who stutter

PURPOSE

The primary aim of this pilot study was to determine the preliminary effectiveness of an online self-compassion intervention for improving self-compassion and quality of life in adults who stutter. A secondary aim was to determine intervention acceptability and participant satisfaction.

METHOD

Participants included adults who stutter who completed an online self-compassion module once a week for six consecutive weeks. Pre- and post-intervention measures included the Self-Compassion Scale-Trait and the Overall Assessment of the Speaker's Experience of Stuttering. Participants also completed acceptability questionnaires weekly and post-intervention via quantitative and qualitative reports.

RESULT

Ten participants completed all six intervention modules, as well as pre- and post-intervention measures. Participants reported increased self-compassion and improved quality of life at post-intervention, as well as high intervention acceptability with regard to delivery format, content, duration, and relevance to stuttering and daily life. Individual variation was also observed across acceptability domains.

CONCLUSION

The present study provides pilot data supporting the use of online modules to increase self-compassion and decrease the negative impact of stuttering on the quality of life among adults who stutter. Future studies should employ larger sample sizes, compare outcomes to a control group, and determine if gains are maintained over time.

A Narrative Review of Compassion Focused Therapy on Positive Mental Health Outcomes

BACKGROUND

Compassion-focused therapy (CFT) has been attracting attention in mental health practice and research. CFT is effective in reducing a variety of negative mental health symptoms. Positive mental health (PMH) focuses on an individual's functioning, quality of life, and well-being, aiming to achieve fulfilment. A need for PMH has been increasingly recognised such as national policies incorporating recovery-oriented approaches. However, how effective CFT is for PMH outcomes remains to be investigated. This narrative review aimed to identify the literature that reports evidence on CFT used against PMH outcomes.

METHODS

Our research questions (RQs) were as follows: RQ1. What PMH outcomes are targeted in CFT intervention research? RQ2. Is CFT effective for PMH?" Medline, Embase, and PsycINFO were searched on the Ovid platform. All studies that mentioned "compassion focused therapy" and "compassion-focused therapy" were searched.

RESULTS

Sixteen RCTs were included published since 2012. Nine studies were from Europe, four from Asia, two from Northern America, and one from Australia and New Zealand. CFT was used for diverse PMH outcomes, and the effects were overall positive. Self-compassion and compassion were the most frequently evaluated outcomes.

CONCLUSIONS

The mechanism of action for CFT on PMH needs to be evaluated. CFT can be used as part of personal recovery in mental health. More evidence from non-WEIRD countries including LMICs is needed.

Relationship of Genetic Polymorphisms and Microbial Composition with Binge Eating Disorder: A Systematic Review

Humans are the result of an evolutionary process, and because of this, many biological processes are interconnected with each other. The intestine-brain axis consists of an intricately connected neuronal-neuroendocrine circuit that regulates the sensation of hunger and satiety. Genetic variations and the consumption of unnatural diets (ultra-processed foods, high contents of sugars, etc.) can override this circuit and cause addiction to certain foods and/or the inability to feel satiety in certain situations. The patients who come to consultations (mainly psychology or nutrition) in an attempt to resolve this problem sometimes fail, which leads to them looking for new strategies based on biological predisposition. This investigation aims to evaluate the genetic studies regarding the microbiota carried out in the last 12 years in humans to try to determine which genes and microbes that have been recently studied are related to patients diagnosed with binge eating disorder or compulsive eating (presenting obesity or not). The protocol followed the PRISMA statement, and the following databases were searched from 2012 until the present day: PubMed, PsycINFO, SCOPUS, and Web of Science. Twenty-four international articles were analyzed, including cross-sectional or exploratory studies; five of them referred to the microbial composition, and in nineteen, the existence of genetic polymorphisms present in binge eating disorder or in compulsive eating could be observed: DRD2, OPRM1, COMT, MC4R, BNDF, FTO, SLC6A3, GHRL, CARTPT, MCHR2, and LRP11. Even though there is still much to investigate on the subject, it must be highlighted that, in the last 4 years, a two-fold increase has been observed in potential markers and in studies related to the matter, also highlighting the importance of different analyses in relation to psychosocial factors and their interaction with the genetic and microbial factors, for which research on the matter must be continued.

Online Video-Mediated Compassion Training Program for Mental Health and Well-Being of University Students

College students experiencing psychological distress have significantly greater negative emotions than students who practice compassionate thinking. We have developed Eight Steps to Great Compassion (ESGC), an innovative brief and no-cost online video training program about how to increase compassion among busy and young adult university students. To examine the effectiveness and benefits of the ESGC, a single-group pre-test-post-test quantitative design with undergraduate university students (N = 92; Mage = 20.39) evaluated its effects. The results from the post-test showed that the ESGC had a significant positive impact on increased feelings of compassion towards oneself, compassion for others, and the sense of personal well-being from the pre-test. The analysis of the PERMA-Profiler subscales also reflected a statistically significant increase in overall well-being and health and a decrease in negative emotions and loneliness. From the Post-Survey Lesson Feedback, 88% of the participants reported significant positive changes in themselves and the way that they live due to the program. These findings appear to show important implications for improving healthy minds and reducing negative emotions among university students.

Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study

OBJECTIVE

This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE).

METHOD

Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion.

RESULTS

The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up.

DISCUSSION

Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE.

PUBLIC SIGNIFICANCE

This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.

A neural network underlying cognitive strategies related to eating, weight and body image concerns

Concerns about food intake, weight and body shape can trigger negatively loaded emotions, which may prompt the use of cognitive strategies to regulate these emotional states. A novel fMRI task was developed to assess the neurobehavioral correlates of cognitive strategies related to eating, weight and body image concerns, such as self-criticism, avoidance, rumination, and self-reassurance. Fourteen healthy females were presented audio sentences referring to these conditions and instructed to repeat these internally while engaging their thoughts with the content of food or body images. Participants were asked to report the elicited emotion and rate their performance. All cognitive strategies recruited a network including the inferior and superior frontal gyri, orbitofrontal and anterior cingulate cortex, insula, and dorsal striatum. These brain regions are involved in emotional, reward and inhibitory control processing. Representational similarity analysis revealed distinct patterns of neural responses for each cognitive strategy. Additionally, self-report measures showed that self-criticism was positively associated with superior frontal gyrus (SFG) activation. Self-compassion scores were negatively correlated with activations in the insula and right putamen, while self-reassurance scores were negatively associated with activity in the orbitofrontal cortex. These findings identify a neural network underlying cognitive strategies related to eating, weight and body image concerns, where neurobehavioral correlation patterns depend on the cognitive strategy.

When the night is too short. Bedtime procrastination, self-compassion, and sleep in a daily diary study

OBJECTIVE

Since sleep is an important part of life and too little sleep can lead to disastrous consequences, it is important to look at the factors that may disturb healthy sleep. While procrastination and in particular bedtime procrastination is such a disruptive factor, self-compassion on the other side might be a protective factor.

METHODS

For this reason, in this study, we took a closer look at the interplay between bedtime procrastination, self-compassion, as well as at the actual sleep outcomes in a longitudinal diary study over 1 week. Our assumption was that bedtime procrastination has a negative impact on sleep outcomes, yet self-compassion could be a protective factor buffering this influence. To enable comparability with a previous study, analyses of variance were carried out.

RESULTS

Utilizing frequentist and Bayesian analyses, we found a consistent negative influence of bedtime procrastination and a positive influence of self-compassion on almost all sleep outcomes. While self-compassion did not entirely mitigate the effect of bedtime procrastination on sleep, its positive impact on sleep outcomes was evident.

CONCLUSIONS

These findings highlight the significance of self-compassion and procrastination in relation to actual sleep behaviour, adding to the existing body of literature on sleep research.

The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder

OBJECTIVE

Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD.

METHOD

There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models.

RESULTS

Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment.

CONCLUSION

The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.

Patient experiences of a 10-weeks weight-neutral treatment program for clinical binge eating disorder in a higher weight population

BACKGROUND

Weight based stigma might drive the development of both higher weight and binge eating disorder (BED). To improve treatment and outcomes, a deeper understanding of how stigma and shame are correlated in clinical encounters is needed. The current study was designed to gain insight into how participating in a 10-weeks weight-neutral treatment program for patients with binge eating disorder and higher weight was experienced.

METHODS

Semi-structured interviews were conducted with 10 patients who had completed the BED treatment. The intervention was group based, addressing stigma and shame, using models of attachment and affect regulation in the presentation of BED. Interviews were analyzed guided by van Manen's hermeneutic-phenomenological approach.

RESULTS

A profound feeling of inferiority due to weight stigma and adverse childhood experiences appeared to have kept the participants stuck in a shame driven carousel  of dieting, weight loss, bingeing, and weight regain. Participants and health care professionals' mutual acknowledgement of driving elements of binge eating appeared to support participants feeling more equal. Feeling equal was described as facilitating increased awareness and tolerance of bodily sensations and emotions, and a deeper understanding and self-caring attitude towards themselves. Feeling less shame was described as important for self-disclosure in family relationships, leading to increased understanding and support from others. Simultaneously, unchanged stigmatizing surroundings were described to relate to challenges with eating patterns and weight after end of treatment.

CONCLUSION

Our findings indicate that relational symmetry, by patients experienced as being met with recognition, compassionate acceptance, and mutual investigation of subjective experience, can contribute to reduction of weight stigma and shame, and the burdensome notion of inferiority experienced by the participants in everyday life, hence improving treatment outcomes. Trail registration The study was approved and registered by the Data Access Committee at Nord-Trøndelag Hospital Trust August 8th, 2019, registration number 2019_2335.

Exploring the association between self-compassion, mindfulness and mindful eating with eating behaviours amongst patients with obesity

Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.

Psychotherapies for eating disorders: findings from a rapid review

BACKGROUND

Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development.

METHODS

The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper.

RESULTS

281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence.

CONCLUSIONS

Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.

Effects of online self-compassionate writing on stigmatizing and affirming self-perceptions: Potential boundary conditions in undergraduate women

This study investigated the effects of an online self-compassionate writing intervention on stigmatizing and affirming self-views toward the body in a sample of college women (N = 254). Participants were randomly assigned to a self-compassionate writing, attentional-control writing, or wait-list control condition for one week, and completed measures of self-compassion, affirming self-perceptions, and stigmatizing self-perceptions at baseline, one-week post intervention, and one-month post intervention. A series of mixed AN(C)OVAs revealed no significant effects by condition or time on stigmatizing or affirming self-views toward the body when controlling for self-esteem, internalized weight stigma, and eating disorder symptomatology. Follow-up exploratory analyses demonstrated no significant effects by condition on the six facets of self-compassion. Notably, participants were significantly more likely to drop out from the study over time if they were lower in self-compassion and self-esteem, and higher in internalized weight stigma at baseline. These results suggest that online self-compassion writing interventions may need to be longer and more potent, especially for women with more entrenched and stigmatized views about their bodies, as well as potential boundary conditions of cultivating self-compassion in a short-term online intervention.

Effects of Self-Compassion Interventions on Reducing Depressive Symptoms, Anxiety, and Stress: A Meta-Analysis

Objectives

A growing body of evidence shows self-compassion can play a key role in alleviating depressive symptoms, anxiety, and stress in various populations. Interventions fostering self-compassion have recently received increased attention. This meta-analysis aimed to identify studies that measured effects of self-compassion focused interventions on reducing depressive symptoms, anxiety, and stress.

Methods

A comprehensive search was conducted within four databases to identify relevant randomized controlled trials (RCTs). The quality of the included RCTs was assessed using the Cochrane Collaboration risk-of-bias tool. Either a random-effects model or fixed-effects model was used. Subgroup analyses were conducted according to types of control groups, intervention delivery modes, and the involvement of directly targeted populations with psychological distress symptoms.

Results

Fifty-six RCTs met the eligibility criteria. Meta-analyses showed self-compassion focused interventions had small to medium effects on reducing depressive symptoms, anxiety, and stress at the immediate posttest and small effects on reducing depressive symptoms and stress at follow-up compared to control conditions. The overall risk of bias across included RCTs was high.

Conclusions

Fewer studies were conducted to compare effects of self-compassion interventions to active control conditions. Also, fewer studies involved online self-compassion interventions than in-person interventions and directly targeted people with distress symptoms. Further high-quality studies are needed to verify effects of self-compassion interventions on depressive symptoms, anxiety, and stress. As more studies are implemented, future meta-analyses of self-compassion interventions may consider conducting subgroup analyses according to intervention doses, specific self-compassion intervention techniques involved, and specific comparison or control groups.

Preregistration

This study is not preregistered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-023-02148-x.

Low intensity psychological interventions for the treatment of feeding and eating disorders: a systematic review and meta-analysis

BACKGROUND

Feeding and eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Low intensity psychological interventions have the potential to increase such access.

METHODS

A systematic review and meta-analysis were conducted on the use of low intensity psychological interventions for the treatment of feeding and eating disorders. Studies comparing low intensity psychological interventions against high intensity therapies and non-eating disorder specific psychological interventions were included, as well as those with waiting list control arms. There were three primary outcomes: eating disorder psychopathology, diagnostic and statistical manual of mental disorders (DSM) severity specifier-related outcomes and rates of remission/recovery.

RESULTS

Thirty-three studies met the inclusion criteria, comprising 3665 participants, and 30 studies were included in the meta-analysis. Compared to high intensity therapies, low intensity psychological interventions were equivalent on reducing eating disorder psychopathology (g = - 0.13), more effective at improving DSM severity specifier-related outcomes (g = - 0.15), but less likely to achieve remission/recovery (risk ratio (RR) = 0.70). Low intensity psychological interventions were superior to non-eating disorder specific psychological interventions and waiting list controls across all three primary outcomes.

CONCLUSION

Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms. Few potential moderators had a statistically significant effect on outcome. The number of studies for many comparisons was low and the methodological quality of the studies was poor, therefore results should be interpreted with caution. More research is needed to establish the effectiveness of low intensity psychological interventions for children and young people, as well as for individuals with anorexia nervosa, avoidant/restrictive food intake disorder, pica and rumination disorder.

The effectiveness of compassion focused therapy with clinical populations: A systematic review and meta-analysis

BACKGROUND

Over the last 20 years, compassion focused therapy (CFT) has gained popularity as an emerging 'third wave' intervention. Although previous reviews indicated its potential benefits, a systematic review and meta-analysis of CFT in those with mental health difficulties has yet to be conducted.

METHODS

A systematic search of five databases was undertaken, focusing on randomised controlled trials and randomised pilot/feasibility studies of CFT only. No language restrictions were implemented. A narrative synthesis was conducted. Random effects meta-analyses were measured on levels of self-compassion, self-criticism/self-reassurance, fears of compassion and clinical symptomology.

RESULTS

Fifteen studies from 2013 to 2022 were included. Findings suggested that CFT was effective in improving compassion-based outcomes and clinical symptomology from baseline to post-intervention and compared to waitlist control. A range of small to large effect sizes were reported for improvements in self-compassion (0.19-0.90), self-criticism (0.15-0.72), self-reassurance (0.43-0.81), fear of self-compassion (0.18), depression (0.24-0.25) and eating disorders (0.18-0.79). Meta-analyses favoured CFT in improving levels of self-compassion and self-reassurance than control groups.

LIMITATIONS

The methodological quality of many of the included studies (7/15) was rated as 'unclear' due to a lack of information. There was a distinct gender gap, with 74.88% identifying as female participants.

CONCLUSIONS

This review was the first to examine the effectiveness of CFT in clinical populations. The results indicate that CFT has promising clinical implications, suggesting that the intervention increases compassion-based outcomes and reduces clinical symptomology in those with mental health difficulties. However, future research is required into the long-term effects of CFT.

A daily diary study of self-compassion and adaptive coping behaviours in women with symptoms of bulimia nervosa

BACKGROUND

Mental health is more than the absence of illness and includes the ability to cope adaptively with stress. To shed light on the factors that promote mental health in people with eating disorders, this daily diary study examined whether daily and trait levels of self-compassion predict adaptive coping behaviours in women with symptoms of bulimia nervosa (BN).

METHODS

Women (N = 124) who met the DSM-5 criteria for BN completed 2 weeks of nightly measures assessing their daily level of self-compassion and their daily adaptive coping behaviours, namely, their use of problem-solving strategies, seeking and receiving of instrumental social support, and seeking and receiving of emotional social support.

RESULTS

Multilevel modelling revealed that on days when self-compassion levels were higher than their personal mean level or than the preceding day's level, participants reported greater use of problem-solving strategies, greater seeking and receiving of instrumental social support, and greater receiving of emotional social support. Daily levels of self-compassion, but not increased self-compassion from the preceding day, were associated with emotional support sought. Further, higher trait self-compassion, as measured by participants' mean level of self-compassion over the 2 weeks, was associated with increased seeking and receiving of instrumental and emotional social support but not with problem-solving strategies. All models controlled for participants' daily and mean eating pathology over the 2 weeks, highlighting the unique contribution of self-compassion to adaptive coping behaviours.

CONCLUSIONS

Results suggest that self-compassion may help individuals with symptoms of BN cope with challenges in their daily life more adaptively, an integral component of positive mental health. The present study is among the first to suggest that the benefits of self-compassion for individuals with eating disorder symptoms may lie not only in facilitating reduced eating pathology, as evidenced by prior research, but also in promoting positive mental health. More broadly, findings underscore the potential value of interventions designed to build self-compassion in individuals with eating disorder symptoms.

The COMFORT trial: a randomised control trial comparing group-based COMpassion-FOcussed therapy and breathing pattern ReTraining with treatment as usual on the psychological functioning of patients diagnosed with cancer recurrence during COVID

BACKGROUND

A cancer diagnosis is a known precipitant of psychological distress, with fear of recurrence being a well-documented distressing consequence of cancer. Cancer recurrence often results in an additional psychological burden, which may exacerbate as a result of the COVID-19 pandemic.

METHODS

This is a single-centre, prospective, randomised controlled trial. Patients identified as having experienced cancer recurrence since March 2020 (the onset of the COVID-19 pandemic in Ireland) will be screened for participation. Eligible, consenting candidates who score 4 or higher on the Distress Thermometer will be enrolled in the study. Participants will be randomly allocated to receive either a 6-week, group-based, online, compassion-focussed therapy and breathing pattern retraining intervention or the control arm. Those in the control arm will all be offered the group intervention after the 18-week study period. The primary outcome is the Distress Thermometer score at 18 weeks post-baseline though secondary outcomes will include measures of mood, traumatic distress and mental adjustment to cancer.

DISCUSSION

To our knowledge, this protocol describes the first RCT which directly examines the effect of a group-based psychological intervention on Irish patients experiencing cancer recurrence in the context of COVID-19. The outcome of this trial is likely to be twofold: It will determine if the psychological intervention achieves its primary objective of distress amelioration 3 months post-intervention and to establish the feasibility of delivering this intervention in a virtual format.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05518591. Registered on 25 August 2022. All items from the World Health Organization Trial Registration Data set have been included.

Feasibility and efficacy of an online compassion-focused imagery intervention for veterinarian self-reassurance, self-criticism and perfectionism

BACKGROUND

Veterinarians report high levels of psychological distress and self-criticism. However, there is minimal research investigating psychological interventions for veterinarians. Evidence suggests that compassion-focused therapy is effective at reducing distress in those with high self-criticism. This study aimed to investigate the feasibility and preliminary effectiveness of a 2-week online compassionate imagery intervention for veterinarians.

METHODS

A one-group repeated measures design was used with 128 veterinarians. Participants completed measures of perfectionism, self-criticism, self-reassurance and fears of compassion four times, at 2-week intervals (at baseline, pre-intervention, post-intervention and 2-week follow-up). Participants answered written questions about their intervention experience post-intervention.

RESULTS

Content analysis of the qualitative data found the intervention to be acceptable and beneficial to participants. Overall, study attrition was 50.8%, which is reasonable for a low-cost intervention. Minimal differences were found between participants who dropped out compared to those who completed the intervention. Perfectionism, work-related rumination and self-criticism were significantly reduced post-intervention, and these effects were maintained at follow-up. Resilience and self-reassurance remained unchanged. Fears of compassion reduced over the baseline period and pre-post intervention, questioning the validity of the measure.

CONCLUSION

Overall, in the context COVID-19, the intervention showed impressive feasibility and preliminary effectiveness. Randomised control trials are recommended as the next step for research to establish the intervention's effectiveness.

Self-compassion training for individuals with social anxiety disorder: a preliminary randomized controlled trial

Self-compassion is the ability to offer oneself kindness and compassion in response to failure, suffering, or insecurity. Learning how to be self-compassionate through self-compassion training appears effective for improving psychological well-being in community samples and promising for clinical populations. The current randomized controlled trial was designed to (a) examine the effectiveness of a self-guided self-compassion training program; and (b) determine whether self-compassion training can help mitigate social anxiety disorder (SAD) symptoms. Adults with SAD (n = 63; Mage = 34.3, SD = 11.4; 67.8% female; 84.7% Caucasian) were randomized to a waitlist control condition, a self-guided self-compassion training condition, or a self-guided applied relaxation training condition for six weeks. Outcome measures of SAD symptoms and self-compassion were completed pre-, mid-, and post-treatment, as well as at 3-months follow-up. Multilevel linear modelling results suggested the self-compassion training program was statistically superior at improving outcome measures relative to the waitlist control condition (ps < .05; η²_ps = .12-.33), but not relative to the applied relaxation training condition (ps > .05; η²_ps = .01-.05). Self-compassion training produced greater clinically significant gains in self-compassion and reductions in fear of self-compassion compared to both the waitlist condition and applied relaxation training. The current trial provides preliminary evidence for the effectiveness of a self-help self-compassion training program and provides evidence that self-compassion training may be beneficial for managing clinically significant SAD symptoms.

Self-Compassion Focused Writing Practices: A Systematic Review

In the current systematic review study, it is focused on examining the interventions of 'self-compassion-focused writing', which is a method that combines the concept of self-compassion, which has gained attention in the psychology literature in recent years, and the Written Emotional Disclosure Paradigm which is based on expressing emotions by writing. For this purpose, ScienceDirect, PsycINFO, Web of Science, PubMed, EbscoHost and DergiPark databases were searched through various keywords. Considering the inclusion and exclusion criteria of the study, 31 studies determined to be fit for purpose were examined in terms of sample characteristics, methodology and results. It was observed that the studies were generally conducted with college students and predominantly female, the results were compared with the active intervention groups, random assignment was made to the groups, and repeated measurements were taken. Generally, it has been determined that self-compassion-focused writing provides positive changes on psychological (depression, positive/negative affect), body-related (body satisfaction, body image) and physical (pain) variables. In the reviewed studies, it was concluded that self-compassion-focused writing generally tended to produce stronger positive results compared to active control groups (traditional writing, self-esteem-based writing). Besides, it was observed that the positive changes obtained in studies that carried out follow-up evaluations tended to continue partially. The results show that self-compassion-focused writing is a promising method.

Enriching sociocultural perspectives on the effects of idealized body norms: Integrating shame, positive body image, and self-compassion

Body image is an integral aspect of the psychology of the self. Idealized body images are ubiquitous in both traditional media forms (e.g., magazines, television) and social media (e.g., Facebook, Instagram). The classic sociocultural model of body image (i.e., the Tripartite Influence Model) emphasizes pathways between idealized body norms, appearance comparisons, internalization of body ideals, and body dissatisfaction and its outcomes. We summarize the model and identify some issues to be addressed in future work, particularly in light of the immense popularity of social media. We review three topics that are not included in the sociocultural model but that provide a more complete picture of the influence of societal body norms on body image: (1) body shame, (2) positive body image, and (3) self-compassion. Research on the nature, assessment, and relevance of these constructs is reviewed in detail. In terms of clinical applications of these areas of research for individuals at risk of body dissatisfaction, we suggest assessing for and targeting body shame, cultivating facets of positive body image, and teaching strategies for developing self-compassion.

Adaptive body image can be contagious: An examination of college women facing situational body image threats

The present research examined whether and which adaptive body image displays in peers can promote more adaptive body image in self. In two studies, female-identified undergraduates recalled a personally distressing body image event. In Study 1, participants (N = 158) then heard an alleged female-identified peer responding to her own distressing body image event with either self-compassion, self-esteem enhancement, or distraction. Participants across conditions reported increased body acceptance and body image-related self-compassion, and decreased body image distress, but changes did not vary by condition. Study 2 sought to determine which component(s) common to Study 1's conditions explained the benefits participants experienced. Participants (N = 207) listened to an alleged peer: describe body image distress with which she coped adaptively; express body image distress but no adaptive coping; or deny body image distress and relate positively to her body. Hearing a peer cope adaptively with body image distress yielded the greatest body image benefits, whereas hearing a peer deny body image distress was generally least helpful. Results suggest that learning how a peer copes adaptively with body image distress may be most helpful in the face of personal body image distress, and support the overarching theory that adaptive body image may be socially transmissible.

The roles of negative emotion intensity, negative emotion differentiation, and self-compassion in loss of control eating

OBJECTIVE

Negative affect intensity is robustly related to binge eating, but the relationship between negative emotion differentiation (i.e., the ability to differentiate negatively-valenced emotions) and binge eating is unclear. Further, little is known about factors that might reduce emotion intensity and/or enhance emotion differentiation, thereby reducing binge eating. Self-compassion is consistently linked to less binge eating, which may be due to decreased negative affect and/or an enhanced ability to differentiate emotions. The current study examined the roles of negative emotion intensity, negative emotion differentiation, and self-compassion in binge eating using ecological momentary assessment.

METHOD

Participants were 201 university students (52.2% female) who completed questionnaires assessing affect seven times a day, and engagement in loss of control (LOC) eating episodes at the end of each day, for 10 days. The average of sadness, fear, guilt, and hostility subscales represented negative emotion intensity; intraclass correlations across negative affect subscales defined negative emotion differentiation. Both daily (i.e., within-person) and trait (i.e., between-person) emotion variables were examined as predictors.

RESULTS

Between-person negative emotion intensity, but not negative emotion differentiation, significantly predicted LOC eating occurrence. Self-compassion had a significant effect on LOC eating frequency, and this relationship was partially mediated via negative emotion intensity, but not via negative emotion differentiation.

DISCUSSION

Lower levels of negative emotion intensity partially account for the relationship between greater self-compassion and less frequent LOC eating. These findings highlight the importance of cultivating self-compassion to down-regulate negative emotions and to reduce LOC eating.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that university students who approach their limitations compassionately experience fewer negative emotions in daily life and engage in less loss of control eating. Lower levels of negative affect partially explain this relationship between self-compassion and loss of control eating. These results highlight the importance of cultivating an understanding and a compassionate attitude toward oneself for reducing eating pathology.

Path to practising self-compassion in a tertiary eating disorders treatment program: A qualitative analysis

OBJECTIVE

Although self-compassion has been shown to facilitate eating disorder (ED) remission, significant barriers to acquiring this skill have been identified. This is particularly true for tertiary care populations, where ED behaviours provide a valued identity and readiness issues are highly salient. In this research, the voices and perspectives of patients who have recovered as well as those in later stages of tertiary care treatment were captured using qualitative methods.

METHODS

Seventeen individuals with a lengthy ED history (seven fully recovered, 10 currently in recovery-focused residential treatment) participated in audio recorded interviews. Using a visual timeline, participants described the development of their understanding of self-compassion, barriers to self-compassion and how these barriers were overcome.

RESULTS

Three processes were identified, reflecting different levels of readiness. Challenging my beliefs involved overcoming cognitive barriers to the concept of self-compassion (i.e. coming to see self-compassion as helpful), and set the stage for dealing with the world around me and rolling up my sleeves, which reflected preparatory (i.e. freeing oneself from difficult life circumstances) and active (i.e. having the courage to do the work) change efforts, respectively.

CONCLUSIONS

These findings may help patients embarking on tertiary care treatment to envision a roadmap of supportive processes and help clinicians tailor interventions to patient level of readiness for self-compassion.

Determining the potential link of self-compassion with eating pathology and body image among women: a longitudinal mediational study

PURPOSE

This longitudinal study aims to determine what factors mediate the previously established link between self-compassion and eating pathology/body image concerns, over a 6-month period.

METHODS

A community sample of 274 adult women (M = 29.50 years) completed standardised validated measures of self-compassion (Self-Compassion Scale), rumination (Ruminative Thought Style Questionnaire), shame (Other as Shamer Scale), perfectionism (Short Form of the Revised Almost Perfect Scale), self-criticism (Levels of Self-Criticism Scale), eating pathology (Eating Disorder Examination Questionnaire) and body image (Body Shape Questionnaire). They reported levels of: self-compassion at Time 1, potential mediators (rumination, shame, self-criticism, perfectionism) at 3 months; and eating pathology and body dissatisfaction a further 3 months later. Missing data were handled using multiple imputation. Stepwise multiple regression showed that shame was the most consistent mediator.

RESULTS

Shame acted as a full mediator of the self-compassion-eating/body image relationship {respectively, [B = .04, SE = .01, t(268) = 3.93, p < .001], [B = .33, SE = .15, t(268) = 2.25, p < .05]}. Discrepancy perfectionism also played a mediating role in the link between self-compassion and body image dissatisfaction [B = .59, SE = .28, t(268) = 2.10, p < .05].

CONCLUSION

These results support the hypothesis that self-compassion is relevant to eating pathology and body image disturbance, and demonstrate that shame is an important mechanism in that relationship. This pattern suggests that interventions that reduce shame should be considered when addressing issues relating to self-compassion and its links to eating disorders.

LEVEL OF EVIDENCE

Level IV, multiple time series without intervention.

Positive body image, intuitive eating, and self-compassion protect against the onset of the core symptoms of eating disorders: A prospective study

OBJECTIVE

Establishing factors that protect against the onset of eating disorder symptoms is needed to identify critical intervention targets to inform the design of more potent prevention programs. Knowledge of robust protective factors is lacking, which might account for the limited effectiveness of existing prevention programs. As positive body image, intuitive eating, and self-compassion show protective potential, the present study tested whether these factors protect against the onset of a range of different eating disorder symptoms.

METHOD

Data were analyzed from 1,270 women who completed study measures at baseline and 8 months. Logistic regressions tested whether, among initially asymptomatic women, baseline and changes in positive body image components (body appreciation, body image flexibility, and functionality appreciation), intuitive eating, and self-compassion predicted the continued absence versus onset of seven core eating disorder symptoms at follow-up.

RESULTS

Each of the five factors at baseline was associated with a lower odds of symptom onset for each outcome in univariate analyses. Baseline body appreciation and intuitive eating scores remained consistent, unique predictors of a lower odds of experiencing symptom onset in multivariate models. Greater increases in intuitive eating and body appreciation over time were the two factors consistently associated with a lower odds of symptom onset across several outcomes.

DISCUSSION

This study provides strong evidence for the protective influence of positive body image components, intuitive eating, and self-compassion against several eating disorder symptoms. Building these factors within established prevention programs may, in the longer term, help reduce the incidence of eating disorder syndromes and symptoms.

Feel Good, Eat Better: The Role of Self-Compassion and Body Esteem in Mothers' Healthy Eating Behaviours

Mothers’ eating behaviours are important to ensure the health and well-being of themselves and their families. Recent research has pointed to self-compassion, defined as extending kindness to oneself in times of perceived inadequacy or general suffering, as a trait associated with healthy forms of eating, such as intuitive eating, and reduced maladaptive forms of eating, such as emotional eating. However, little is known about the psychological mechanism through which self-compassion relates to healthy eating behaviours. This study examined 100 mothers’ levels of self-compassion, body esteem and eating behaviours. Structural equation modelling revealed that self-compassion was positively associated with diet quality and intuitive eating, while being negatively associated with emotional eating. Moreover, these links occurred, in part, due to higher body esteem. This points to a mechanism through which self-compassion may positively contribute to mothers’ healthy eating behaviours. The implications for eating outcomes and women’s health are discussed.

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

Self-compassion and dissonance-based interventions for body image distress in young adult women

Self-compassion interventions have been suggested as a potentially more acceptable way to address body image distress compared to interventions that emphasize challenging (often firmly entrenched) thin-ideals. In the current randomized controlled trial, young adult women endorsing body image concerns were randomized to a self-compassion (SC) intervention consisting of one in-person session plus one week of self-guided practice (n = 50), a similarly-structured dissonance-based (DB) intervention (n = 50), or a waitlist (WL) control (n = 51). Both brief interventions were acceptable and were more effective than WL. The two interventions did not differ significantly from each other in reducing the global measure of body dissatisfaction, improving body appreciation, or reducing appearance-contingent self-worth. The DB intervention alone decreased thin-ideal internalization, but only among participants with initially high scores. More participants initially expressed a preference for the SC rationale, and at post-test SC participants reported a higher likelihood of recommending the intervention they had received to others. Change in self-compassion emerged as a possible mechanism of action within both interventions, suggesting it may be useful to integrate aspects of both approaches to enhance acceptability and provide the greatest benefits.

A two-week daily diary study examining the association between daily self-compassion and symptoms of bulimia nervosa

OBJECTIVES

Individuals with symptoms of bulimia nervosa (BN) are more likely to binge and purge on days of greater negative affect. Given that self-compassion helps individuals cope more adaptively with distress, the present study examined the contribution of daily fluctuations in self-compassion to eating disorder symptoms in women who endorse symptoms of BN. The directionality of these associations was also examined.

METHOD

For 2 weeks, 124 women who met the DSM-5 criteria for BN completed nightly measures of their daily eating pathology and self-compassion.

RESULTS

Self-compassion levels varied almost as much within a person from day-to-day as between-persons (i.e., from one person to the next). Multilevel modeling revealed that within persons, higher daily levels of self-compassion were associated with a reduced probability of both binge eating and inappropriate compensation, and lower levels of dietary restraint and clinical impairment. Secondary analyses revealed that these variables mutually influenced one another within but not across days. Between persons, higher mean levels of self-compassion over the 2 weeks were associated with less dietary restraint and clinical impairment but were unrelated to binge eating and compensatory behaviors.

DISCUSSION

For women who report symptoms consistent with BN, responding to daily distress with greater self-compassion than usual may attenuate the psychosocial and behavioral symptoms of their eating disorder. Similarly, days of reduced eating pathology may facilitate self-compassion. Future research using experimental paradigms and ecological momentary assessments may shed further light on the ways in which self-compassion and eating pathology relate to one another in this population.

Self-compassion training within a workplace physical activity program: A pilot study

BACKGROUND

Desire2Move (D2M) is an 8-week team-based, workplace program that incorporates competition and self-monitoring to encourage physical activity (PA).

OBJECTIVE

The purpose of this pilot study was to evaluate the effectiveness of a self-compassion (SC) intervention within the existing workplace PA program.

METHODS

University employees (n = 20) were assigned to a SC treatment group or an attention control group. Participants logged their PA minutes using MapMyRun. Treatment group. participants received a 7-week, SC podcast intervention. Participants self-reported PA, SC, and demographic information at pre- and post-intervention. Separate ANOVAs were used to determine group differences.

RESULTS

There was not a statistically significant group x time interaction for SC, F(1, 18) = 0.02, p = 0.90, or main effects for time, F(1, 18) = 0.28, p = 0.61, or group, F(1, 18) = 1.70, p = 0.21, g = -0.42 [95%CI = -3.13, 2.29]. There were not significant differences between groups for total PA minutes during D2M, F(1, 18) = 2.15, p = 0.16, g = -0.63 [-1.53,0.27]. Overall, participants engaged in more than the recommended levels of PA each week.

CONCLUSIONS

This pilot study provided feedback and guidance for future online SC training within a workplace PA intervention.

Changes in the Semantic Construction of Compassion after the Cognitively-Based Compassion Training (CBCT®) in Women Breast Cancer Survivors

The growing body of research on compassion has demonstrated its benefits for healthcare and wellbeing. However, there is no clear agreement about a definition for compassion, given the novelty of the research on this construct and its religious roots. The aim of this study is to analyze the mental semantic construction of compassion in Spanish-speaking women breast cancer survivors, and the effects of the Cognitively-Based Compassion Training (CBCT®) on the modification of this definition, compared to treatment-as-usual (TAU), at baseline, post-intervention, and six-month follow-up. Participants were 56 women breast cancer survivors from a randomized clinical trial. The Osgood's Semantic Differential categories (evaluative, potency, and activity scales) were adapted to assess the semantic construction of compassion. At baseline, participants had an undefined idea about compassion. The CBCT influenced subjects' semantic construction of what it means to be compassionate. Findings could lead to future investigations and compassion programs that adapt to a specific culture or population.

The Effects of Self-Compassion and Self-Esteem Writing Interventions on Women’s Valuation of Weight Management Goals, Body Appreciation, and Eating Behaviors

In this study, we examined the effects of body-focused daily self-compassion and self-esteem expressive writing activities on women’s valuation of weight management goals, body appreciation, bulimic symptoms, and healthy and unhealthy eating behaviors. One-hundred twenty-six women, recruited from the community and a university participant pool ( Mage = 29.3, SD = 13.6), were randomly allocated to one of the three writing conditions: body-focused self-compassion, body-focused self-esteem, or control. Women reflected on a moment within the past 24 hours that made them feel self-conscious about their bodies, eating, or exercise habits (self-compassion and self-esteem conditions) or on a particular situation or feeling that occurred in the past 24 hours (control condition) for 4–7 days. At post-treatment (24 hours after the intervention), women in the self-compassion group demonstrated decreased bulimic symptoms, while women in the self-esteem and control conditions did not. Furthermore, clinically significant changes in bulimic symptoms were associated with being in the self-compassion condition but not in the self-esteem or control conditions. Results suggest that body-focused writing interventions may be more effective in temporarily reducing eating disorder symptoms in women if they focus on harnessing self-compassion. Additional online materials for this article are available on PWQ ’s website at http://journals.sagepub.com/doi/suppl/10.1177/03616843211013465

On loving thyself: Exploring the association between self-compassion, self-reported suicidal behaviors, and implicit suicidality among college students

Suicide is a major public health concern. It is unknown whether self-compassion is associated with suicide risk above and beyond suicide risk factors such as self-criticism, hopelessness, and depression severity. Participants: Participants were 130 ethnically diverse undergraduate college students. Methods: Participants completed self-report measures of self-compassion, self-criticism, hopelessness, depression severity, and suicidal behaviors, as well as an implicit measure of suicidality. Results: Self-compassion was significantly associated with self-reported suicidal behaviors, even when controlling for self-criticism, hopelessness, and depression severity. Self-compassion was not significantly associated with implicit suicidality. Conclusions: The findings suggest that self-compassion is uniquely associated with self-reported suicidal behaviors, but not implicit suicidality, and that self-compassion is a potentially important target in suicide risk interventions. Limitations and future research directions are discussed.

Stressed, depressed, and rank obsessed: Individual differences in compassion and neuroticism predispose towards rank-based depressive symptomatology

OBJECTIVES

As social creatures, we monitor our relative rank and/or status with others via social comparisons. Whilst research has identified perceptions of inferiority or 'low rank' relative to others is a robust predictor of depressive, anxious, and stress symptomology, to date individual differences have been ignored. We wish to provide empirical evidence to outline how differences across personality traits may interact with social rank variables to buffer or predispose towards depressive symptomology.

METHODS

Across three independent samples (N = 595), we replicated a social rank model of mental health, and with our third sample (N = 200), we sought to investigate attenuating roles for neuroticism versus compassion with multiple moderated regression models.

RESULTS

Neuroticism predicted greater levels of rank-associated depression, and compassion failed to function as a protective factor for rank-associated depression. However, a closer inspection of the original Big-5 factor structure positions this scale as a measure of 'interpersonal submissiveness' or 'conflict appeasement' rather than genuine compassion.

CONCLUSIONS

Whilst it is necessary to delineate the conditions where compassion is appropriate and able to lead to positive mental health outcomes, we argue this cannot be addressed with the Big-5 measure of trait compassion. We call for future work to consider valid and reliable measures for compassion, such as the self-compassion scale, submissive compassion scale, and fears of compassion scale, to more fully address how compassion may protect against both rank-based comparisons and severity of depression.

PRACTITIONER POINTS

Social rank mechanisms are robustly implicated in depression, anxiety, and stress. Clients who present as higher in neuroticism, inferiority, or submissiveness may be more prone towards rank-associated depression symptoms. Preliminary evidence suggests cultivation of genuine compassion can shift clients from a rank-focussed to a compassionate-focussed mentality, which aids mental health and fosters well-being.

The protective effects of self-compassion on alcohol-related problems among First Nation adolescents

Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high-degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e., the ability to be kind and accepting and to extend compassion towards oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N=106, M _age =14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b=-.51, p=.01, 95%CI [-.90, -.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b=-.42, p=.04, 95%CI [-.82, -.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b=4.68, p<.001, 95%CI [2.62, 6.73]), but was not significant at high (b=-.29, p=.89, 95%CI [-4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR=0.90, 95%CI [0.83, 0.98], p=.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions.

Effectiveness of self-compassion-related interventions for reducing self-criticism: A systematic review and meta-analysis

Self-criticism is the process of negative self-evaluation. High levels are associated with psychopathology and poorer therapeutic outcomes. Self-compassion interventions were developed to explicitly target self-criticism. The aim of this review was to estimate the overall effect of self-compassion-related interventions on self-criticism outcomes and investigate potential moderating variables. A systematic search of the literature identified 20 randomized controlled trials (RCTs) that met the inclusion criteria. Nineteen papers, involving 1350 participants, had sufficient data to be included in the meta-analysis. Pre- and post-data points were extracted for the compassion and control groups. Study quality was assessed using an adapted version of the Cochrane Collaboration's risk of bias tool, which concluded that studies were of moderate quality. Meta-analysis findings indicated that self-compassion-related interventions produce a significant, medium reduction in self-criticism in comparison with control groups (Hedges' g = 0.51, 95% CI [0.33-0.69]). Moderator analysis found greater reductions in self-criticism when self-compassion-related interventions were longer and compared with passive controls rather than active. The remaining moderators of forms of self-criticism, sample type, intervention delivery, intervention setting and risk of bias ratings were insignificant. Overall, the review provides promising evidence of the effectiveness of self-compassion-related interventions for reducing self-criticism. However, results are limited by moderate quality studies with high heterogeneity. Directions for future research indicate that more RCTs with active controls, follow-ups, consistent use and reporting of measures and diverse samples are needed.