Randomised Controlled Trial of an Online Version of Compassion Mind Training in a Nonclinical Sample

Application of Positive Psychology in Digital Interventions for Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Controlled Trials

BACKGROUND

The rising prevalence of mental health issues in children, adolescents, and young adults has become an escalating public health issue, impacting approximately 10%-20% of young people on a global scale. Positive psychology interventions (PPIs) can act as powerful mental health promotion tools to reach wide-ranging audiences that might otherwise be challenging to access. This increased access would enable prevention of mental disorders and promotion of widespread well-being by enhancing self-efficacy, thereby supporting the achievement of tangible objectives.

OBJECTIVE

We aimed to conduct a comprehensive synthesis of all randomized controlled trials and controlled trials involving children, adolescents, and young adults, encompassing both clinical and nonclinical populations, to comprehensively evaluate the effectiveness of digital PPIs in this age group.

METHODS

After a literature search in 9 electronic databases until January 12, 2023, and gray literature until April 2023, we carried out a systematic review of 35 articles, of which 18 (51%) provided data for the meta-analysis. We included randomized controlled trials and controlled trials mainly based on web-based, digital, or smartphone-based interventions using a positive psychology framework as the main component. Studies included participants with a mean age of <35 years. Outcomes of PPIs were classified into indicators of well-being (compassion, life satisfaction, optimism, happiness, resilience, emotion regulation and emotion awareness, hope, mindfulness, purpose, quality of life, gratitude, empathy, forgiveness, motivation, and kindness) and ill-being (depression, anxiety, stress, loneliness, and burnout). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the selection of studies and data extraction. Quality assessment was performed following the CONSORT (Consolidated Standards of Reporting Trials) guidelines.

RESULTS

For well-being outcomes, meta-analytic results showed that PPIs augmented the feeling of purpose, gratitude, and hope (Hedges g=0.555), compassion (Hedges g=0.447), positive coping behaviors (Hedges g=0.421), body image-related outcomes (Hedges g=0.238), and positive mindset predisposition (Hedges g=0.304). For ill-being outcomes, PPIs reduced cognitive biases (Hedges g=-0.637), negative emotions and mood (Hedges g=-0.369), and stress levels (Hedges g=-0.342). Of note, larger effect sizes were found when a waiting list control group was considered versus a digital control group. A funnel plot showed no publication bias. Meta-regression analyses showed that PPIs tended to show a larger effect size on well-being outcomes in studies including young adults, whereas no specific effect was found for ill-being outcomes.

CONCLUSIONS

Revised evidence suggests that PPIs benefit young people's well-being and mitigate ill-being symptoms. Digital platforms offer a unique way to address their mental health challenges, although not without limitations. Future research should explore how they work for the needs of the young population and further examine what specific PPIs or combination of interventions is most beneficial with respect to other digital control groups.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023420092; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420092.

Compas-Y: A mixed methods pilot evaluation of a mobile self-compassion training for people with newly diagnosed cancer

Objective

Compas-Y is a compassionate mind training app that was co-designed to be fully adapted to mobile technology and to people with newly diagnosed cancer. This study aimed to evaluate the use, appreciation and impact of the app.

Methods

Seventy-one people with cancer who created an app account were included (38% breast cancer, 72% diagnosed <4 months ago, 76% received chemotherapy). Participants had very high baseline scores of self-compassion. In a convergent mixed methods design, back-end log-data (n = 71), pre-post surveys (n = 34) and semi-structured interviews (n = 23) collected for >8 weeks and were concurrently analysed using joint displays.

Results

About half of the participants (45%) used 4 of the 6 modules. Compas-Y was highly appreciated, with all content considered relevant and a source of support. Experienced benefits related to improved mental health. Particularly, we found significant changes in anxiety, but not in depression or well-being. In the interviews, people reported experiencing more rest and more positive emotions due to using the app. Process benefits included significant reductions in self-criticism (inadequate self and self-blame), but not self-compassion. In the interviews, people reported improved self-compassion and less self-criticism, more self-awareness, recognition and support, and improved emotion regulation and coping. The surveys did not capture the full range of outcomes that participants reported in the interviews.

Conclusions

Compas-Y is a highly appreciated mobile intervention that supported users in aspects of their mental health. Findings are discussed in terms of reach and adherence, app functionalities, co-design and tailoring of cancer-related and compassion-based eHealth.

Exploring the Cross-cultural Applicability of a Brief Compassionate Mind Training: a Study Comparing Sri Lankan and UK People

Objectives

Compassionate Mind Training (CMT) is a therapeutic approach proven to be effective for reducing distress and increasing well-being in clinical and non-clinical populations. This study aimed to explore the efficacy of a short-term, online version of the CMT on compassion, distress, and well-being in a cross-cultural, non-clinical sample of Sri Lankan and UK people.

Method

A randomized controlled trial with pre-, post-measurements, and a 2-week follow-up was conducted using CMT (n = 21 Sri Lankan, n = 73 UK) and wait-list control (n = 17 Sri Lankan, n = 54 UK) groups. The intervention effects were investigated using a series of repeated-measures ANOVAs using intention-to-treat and per-protocol analyses.

Results

The 2-week CMT was effective in increasing all aspects of compassion in both Sri Lankan and UK people. In addition, some cross-cultural similarities and differences (in the factors affecting compassion) were present in the improvements following CMT between the two countries, which were maintained at a 2-week follow-up.

Conclusion

This study provides promising evidence for the efficacy and cross-cultural applicability of CMT for reducing distress and increasing well-being.

A WeChat-based self-compassion training to improve the treatment adherence of patients with schizophrenia in China: Protocol for a randomized controlled trial

Background

At present, adherence to antipsychotic treatment is often poor, leading to the recurrence of symptoms. This increases the likelihood of the patient experiencing disability and thus increases the disease burden for the patient, their family, and society as a whole. However, to date, there is no clear evidence regarding the effect of medication adherence interventions on outcomes for patients with schizophrenia. Moreover, the traditional intervention methods are limited by manpower and resources in low- and middle-income countries. Recent studies have demonstrated that increasing a patient’s level of self-compassion may improve their treatment adherence. Online mental health care interventions have advantages in terms of feasibility and acceptability for patients with schizophrenia. In this regard, a WeChat-based self-compassion training protocol to improve patient treatment adherence was designed in this study and will be evaluated in the future to determine its impact on patients with schizophrenia.

Methods

The protocol for the randomized controlled trial (RCT) is based on the SPIRIT 2013 statement. This parallel RCT will aim to recruit 392 patients with schizophrenia who will be randomized at a 1:1 ratio into a 3-week intervention or control group. Both groups will receive routine care. The intervention group will also receive WeChat-based self-compassion training, which requires participants to complete three tasks every day, including a reading task, a meditation task, and a self-compassion journal task. The control group will receive WeChat-based psychological health education, which will only require participants to read positive articles about psychological health every day. Medication adherence, self-compassion, stigma, and social support will be measured at baseline (T0), immediately after the intervention (T1), and 3 weeks after the intervention (T2). Program feasibility will be evaluated throughout the course of the study, and acceptability will be measured immediately after the intervention (T1).

Expected results:

The intervention described here will address the barriers to accessing mental health care for people with schizophrenia, including patients’ desire for independent management, difficulty accessing providers, and concerns about privacy and stigma. The current study provides guidance for clinical nurses to carry out psychological intervention, with the ultimate aim of addressing the problems associated with a shortage of psychological professionals in low- and middle-income countries.

An internet-based compassion course for healthcare professionals: Rationale and protocol for a randomised controlled trial

BACKGROUND

Severe stress is one of the most common causes of sick leave in Sweden. Previous research has shown that compassion interventions for healthcare professionals can decrease work-related stress through the introduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations. Internet-based stress management interventions have hitherto shown promising results in reducing stress. However, further research is needed to examine the effectiveness of internet-based compassion interventions for healthcare professionals.

OBJECTIVE

In the present study protocol, a randomised controlled trial is described, aiming to examine the effects of an internet-based compassion course for healthcare professionals on work-related stress and stress of conscience.

METHOD

Healthcare professionals will be offered an internet-based stress management course of five modules across a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled in one of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n = 120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stress management course (n = 36). We hypothesise that the internet-based compassion course would reduce the participants' stress of conscience to a greater degree compared to the other two groups. The secondary hypothesis is that the compassion course would increase the participants' professional quality of life (i.e., higher job satisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion course is expected to reduce the participants' work-related stress and sick leave rates to the same degree (non-inferiority) as the cognitive behavioural stress management course and to a higher degree when compared to the waitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondary outcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related Stress Copenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will be performed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10 weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimating equation for repeated measurements to examine whether changes over time differ between the groups and whether the improvements persist over time.

DISCUSSION

The clinical trial is expected to provide novel data on the effects of compassion interventions and add to the existing knowledge of internet-based interventions for stress management in healthcare professionals.

A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion-focused therapy for chronic illness

Literature suggests that acceptance and commitment therapy (ACT) is effective in improving well-being and in reducing psychopathological symptoms commonly experienced by people with chronic illness (CI). Compassion-focused therapy (CFT) reduces psychological distress, especially in individuals with high levels of shame and self-criticism, but few studies have explored CFT in CI. Additionally, studies almost exclusively compared ACT and CFT with inactive controls (wait-list; treatment as usual). Also, there is an interest in developing cost-effective mental health solutions, such as low-intensity online psychological interventions. This randomized controlled trial (RCT) aimed to assess the acceptability and compare the efficacy of four-session online ACT (n = 25) and CFT (n = 24) interventions in a sample of people with CI. Results showed both interventions were acceptable, with attrition rates at post-intervention comparable to those found in similar studies (around 50%). Intention-to-treat analyses showed that participants presented significantly less illness-related shame, less uncompassionate self-responding and more valued living after the intervention, although no difference was found between conditions. Results were sustained at 3- and 6-month follow-up. Results did not find statistical differences between conditions through reliable change index (RCI). Correlation between demographics and RCI showed that, at post-intervention, younger participants presented more behavioural awareness, men presented more valued action, and participants with CI for shorter periods presented less uncompassionate self-responding and less anxiety. Results suggest that low-intensity (four sessions) online ACT and CFT are cost-effective approaches to promote mental health of individuals with CI. Results and limitations are thoroughly discussed.