Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design.
ABSTRACT: Obsessive-compulsive disorder (OCD) is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients (N = 8) who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD (CFT-OCD), and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances (post-treatment and follow-up data collection were carried out, respectively, at the beginning and in the middle of the Italian lockdown due to the COVID-19 pandemic), by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments.
Project description:CONTEXT:Breast cancer (BC) requires a significant psychological adaptation once treatment is finished. There is growing evidence of how compassion training enhances psychological and physical well-being, however, there are very few studies analyzing the efficacy of compassion-based Interventions on BC survivors. OBJECTIVE:To study the efficacy of the Cognitively-Based Compassion Training (CBCT) protocol in a BC survivor sample on quality of life, psychological well-being, fear of cancer recurrence, self-compassion, and compassion domains and mindfulness facets. Furthermore, enrollment, adherence, and satisfaction with the intervention were also analyzed. METHODS:A randomized clinical trial was designed. Participants (n = 56) were randomly assigned to CBCT (n = 28) or a treatment-as-usual control group (TAU; n = 28). Pre-post intervention and 6-month follow-up measures took place to evaluate health-related quality of life, psychological well-being; psychological stress, coping strategies, and triggering cognitions; self-compassion and compassion; and mindfulness in both intervention and wait-list groups. RESULTS:Accrual of eligible participants was high (77%), and the drop-out rate was 16%. Attendance to CBCT sessions was high and practice off sessions exceeded expectations). CBCT was effective in diminishing stress caused by FCR, fostering self-kindness and common humanity, and increasing overall self-compassion scores, mindful observation, and acting with awareness skillsets. CONCLUSION:CBCT could be considered a promising and potentially useful intervention to diminish stress caused by FCR and enhance self-kindness, common humanity, overall self-compassion, mindful observation, and acting with awareness skillsets. Nevertheless, future randomized trials are needed and a process of deeper cultural adaptation required.
Project description:Virtual reality has been successfully used to study and treat psychological disorders such as phobias and posttraumatic stress disorder but has rarely been applied to clinically-relevant emotions other than fear and anxiety. Self-criticism is a ubiquitous feature of psychopathology and can be treated by increasing levels of self-compassion. We exploited the known effects of identification with a virtual body to arrange for healthy female volunteers high in self-criticism to experience self-compassion from an embodied first-person perspective within immersive virtual reality. Whereas observation and practice of compassionate responses reduced self-criticism, the additional experience of embodiment also increased self-compassion and feelings of being safe. The results suggest potential new uses for immersive virtual reality in a range of clinical conditions.
Project description:Emotion Focused Training for Self-Compassion and Self-Protection (EFT-SCP) is a novel intervention developed on the basis of the latest findings on self-criticism from Emotion-focused therapy and existing programs designed to cultivate compassion. EFTSCP is designed to encourage participants to cultivate self-compassion and protective anger as a way of reducing selfcriticism. Our goal was to investigate the effect of this group-based intervention on self-criticism, self-protection, and self-compassion. A total of 73 students were assigned to the EFT-SCP intervention (n=19), no-treatment control (n=34) or to an active control group (n=20). The intervention group met weekly for 1.5 hours and were instructed to incorporate EFT-SCP tasks into their daily life for 12 weeks. Whilst the no-treatment group did not undergo an intervention, the active control group completed an adapted expressive writing task once a week. In addition to the assessment of heart rate variability during imagery tasks, participants also completed self-reported measures of self-compassion and self-criticism before and after the intervention. Compared with both control groups, the intervention group showed a significant increase in heart rate variability following EFT-SCP (during self-critical imagery, P=.049; probability of superiority was .63, and during self-compassionate imagery P=.007; probability of superiority was .62, both effect sizes were medium) and significant decreases in selfcriticism (Hated Self P=.017; .34 and Inadequate Self P<.001; .33) and self-uncompassionate responding (P<.001; .39). All three effect sizes were small. Participating in EFT-SCP had a positive effect on psychological and physiological outcomes.
Project description:<h4>Background</h4>This article describes the research activities undertaken to plan and design a self-compassion intervention for family carers of people living with dementia using a person-based and co-design approach. In providing this example, our aim is two-fold: to highlight the value of using qualitative research and co-design processes within intervention development; and to showcase systematic reporting of an intervention's early planning and design stages.<h4>Methods</h4>A person-based and co-design approach informed the planning and design of the self-compassion intervention. In Stage 1, qualitative interviews were undertaken with 14 family carers of people living with dementia and 14 professional stakeholders. In Stage 2, intervention guiding principles were developed, psychological theory was incorporated, and six family carers of people living with dementia were engaged as co-designers.<h4>Results</h4>Knowledge generated during intervention planning identified that the intervention should be situated within the concept of compassion more broadly; address misperceptions, fears, blocks, and resistances to self-compassion; and target feelings of shame, guilt, and self-criticism. Subsequent intervention design activities determined that the needs of family carers of people living with dementia were best met by tailoring an existing intervention, namely group-based Compassion-Focused Therapy.<h4>Conclusions</h4>Our systematic approach highlights the value of incorporating in-depth qualitative research and co-design within the intervention development process to prioritise the perspectives and lived experiences of family carers of people living with dementia. The planning and design process outlined provides insight that is applicable to the development of our intervention and complex health interventions within gerontology and beyond.
Project description:<h4>Objectives</h4>The clinical significance of self-criticism and self-compassion has prompted the development of questionnaires assessing these constructs. However, there is a lack of measures assessing their interaction within specific contexts and potential involvement in mood repair processes.<h4>Design</h4>To rectify this, we developed the Self-Compassion and Self-Criticism Scales (SCCS), based on responses to specific scenarios, and examined its psychometric properties in an online survey and an experimental situation.<h4>Method</h4>In study 1, standard psychometric procedures were used to investigate the reliability and validity of the SCCS. In study 2, an experimental challenge involving a difficult language task was used to test its sensitivity to change.<h4>Results</h4>In study 1, exploratory factor analysis (n = 413) showed a clear two-factor structure of the SCCS denoting two orthogonal scales, with high internal validity (? ? .87). Correlations between the SCCS and existing measures also demonstrated appropriate convergent validity. Study 2 (n = 90) provided preliminary evidence that the SCCS can detect changes in self-appraisals. Participants receiving no performance feedback from the challenge task showed reduced state self-criticism and increased state self-compassion, demonstrating mood repair.<h4>Conclusions</h4>The SCCS has promise as a situational measure of self-compassion and self-criticism.<h4>Practitioner points</h4>In the context of specific problem situations, clients' levels of self-criticism and self-compassion may well be orthogonal and can be assessed with the SCCS. In setting treatment goals and assessing treatment outcome, it may be helpful to target both self-compassion and self-criticism separately.
Project description:Objectives:Self-critical behavior is especially relevant for university students who face academic and non-academic stressors, leading to negative outcomes such as mental distress and psychopathologies. To address this behavior, mindfulness and compassion are important factors to decrease self-criticism and ensure positive outcomes. This study examined the psychological and physiological effects of an intervention, the Mindful Lovingkindness Compassion Program (MLCP), on highly self-critical university students in South Korea. Methods:Thirty-eight university students with a high level of self-criticism were assigned to an MLCP group (n = 18) or waitlist (WL) group (n = 20). Self-report measures of self-criticism, self-reassurance, psychological distress, and other mental health variables were completed, and the physiological measure of heart rate variability (HRV) was conducted before and after the intervention with both groups. In addition, 1- and 3-month follow-up assessments were conducted using self-report measurements. Results:Compared to the WL group, participants in the MLCP group experienced significantly greater reductions in self-criticism and psychological distress, and a greater increase in self-reassurance, mental health, and HRV. The improvements in the self-report measures were maintained when assessed 1 and 3 months later. Conclusions:MLCP could be a promising intervention for alleviating self-criticism and increasing self-reassurance among self-critical individuals.
Project description:<b>Introduction:</b> Many individuals and families are currently experiencing a high level of COVID-19-related stress and are struggling to find helpful coping mechanisms. Mindfulness-based interventions are becoming an increasingly popular treatment for individuals experiencing depression and chronic levels of stress. The app (Serene) draws from scholarly evidence on the efficacy of mindfulness meditations and builds on the pre-existing apps by incorporating techniques that are used in some therapies such as cognitive behavioral therapy and mindfulness-based cognitive therapy. <b>Methods:</b> Participants were randomly assigned to a 4-week mindfulness and self-compassion-based cognitive smartphone intervention (Serene) or a wait-list control group. They were instructed to engage in self-compassion and mindfulness practices and a cognitive restructuring task. They also completed measures that evaluated their levels of depression, stress, anxiety, self-compassion, wisdom, psychological well-being, and subjective well-being. The intervention group was also instructed to track their weekly engagement with the app. Standardized effect sizes for between-group differences were calculated using Cohen's <i>d</i> for complete case analyses. <b>Results:</b> Complete case analyses from baseline to the end of this randomized controlled trial demonstrated significant moderate between-group differences for depressive symptoms (<i>d</i> = -0.43) and decisiveness (<i>d</i> = 0.34). Moderate between-group differences were also found for self-compassion (<i>d</i> = 0.6) such that significant improvements in self-kindness, common humanity, mindfulness and decreases in self-judgement, isolation, and overidentification were observed. A small between-group difference was found for emotional regulation (<i>d</i> = 0.28). Moreover, a significant moderate within-group decrease in stress (<i>d</i> = -0.52) and anxiety symptoms (<i>d</i> = -0.47) was also observed in the intervention group. <b>Conclusions:</b> Serene is an effective intervention that promotes increased levels of self-compassion and emotional regulation. Engaging with Serene may help reduce depressive symptoms through mindfulness, self-compassion, and cognitive restructuring which help reduce overidentification with one's negative emotions. As individuals rebalance their thinking through cognitive restructuring, they can identify the varying stressors in their life, develop action plans and engage in adaptive coping strategies to address them. Serene may promote greater self-understanding which may provide one with a more balanced perspective on their current upsetting situations to positively transform their challenges during the pandemic.
Project description:<h4>Unlabelled</h4>Although self-compassion is considered a promising change agent in the treatment of posttraumatic stress disorder (PTSD), no studies of this hypothesis exist. This study examined the within-person relationship of self-compassion components (self-kindness, common humanity, mindfulness, self-judgment, isolation, over-identification) and subsequent PTSD symptoms over the course of therapy.<h4>Method</h4>PTSD patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure (IE) to the traumatic memory, or modified prolonged exposure, where imagery re-scripting (IR) of the memory replaced IE as the imagery component of prolonged exposure in a 10 weeks residential program. They were assessed weekly on self-compassion and PTSD symptom measures. The centering method of detrending was used to separate the variance related to the within-person process of change over the course of treatment from between-person variance.<h4>Results</h4>The self-compassion components self-kindness, self-judgment, isolation, and over-identification had a within-person effect on subsequent PTSD symptoms. These relationships were independent of therapy form. The within-person relationship between self-judgment and subsequent PTSD symptoms was stronger in patients with higher initial self-judgment. By contrast, there were few indications that within-person variations in PTSD symptoms predict subsequent self-compassion components.<h4>Conclusion</h4>The results support the role of self-compassion components in maintaining PTSD and imply the recommendation to facilitate decrease of self-judgment, isolation, and over-identification and increase of self-kindness in the treatment of PTSD patients. The reduction of self-judgment appears to be most important, especially for patients with a high initial level of self-judgment.
Project description:Self-compassion has shown to be beneficial for individuals' wellbeing; in particular, it has been associated with lower levels of depressive symptoms. The purpose of this study was to further explore the association between self-compassion, as measured by the Self-Compassion Scale (SCS), and depressive symptoms, in a large representative sample of community adults (n?=?734, Mean age?=?55.7, SD?=?15.2). We examined the association of depressive symptoms with the SCS total score, the SCS six subscales (i.e., self-kindness, common humanity, mindfulness, self-judgment, isolation, and over-identification), and the SCS positive and negative items (referred to as self-compassion and self-coldness, respectively). In addition, we explored the predictive ability of self-compassion, self-coldness, and the SCS six subscales on depressive symptoms both cross-sectionally and over a 1-year period of time. Finally, we sought to test the moderating role of self-compassion on the association between self-coldness and depressive symptoms. Results showed that the SCS negative items and subscales were more strongly related to depressive symptoms than the SCS positive items and subscales. Accordingly, self-coldness was a stronger predictor of depressive symptoms, cross-sectionally and over a 1-year timeframe, when compared with self-compassion. Particularly, the feeling of being isolated was shown to be strongly associated with depressive symptoms. We did not find substantial evidence for a moderating role of self-compassion on the association between self-coldness and depressive symptoms. Future research needs to determine the added value of assessing self-coldness and whether or not it is an essential part of self-compassion.
Project description:Lesbian, gay, and bisexual (LGB) men and women represent one of the highest-risk populations for depressive symptomatology and disorders, with young LGB adults being at greatest risk. To date, there have been no randomized controlled trials (RCT) to specifically target depressive symptoms in young LGB adults. This is despite research highlighting unique predictors of depressive symptomatology in this population. Here we outline a protocol for an RCT that will test the preliminary efficacy of a tailored compassion-focused therapy (CFT) intervention for young LGB adults compared with a self-directed cognitive behavioral therapy (CBT) program with no specific tailoring for LGB individuals.The CFT intervention consists of 8 units with self-directed reading and activities tailored to LGB young adults, and 8 x weekly 1-hour consultations with a therapist. The CBT intervention consists of 8 units with self-guided reading and activities, with 1 x 1-hour session with a therapist at the mid-point of therapy. Fifty LGB individuals with scores of 13 or above on the Beck Depression Inventory-II will be randomized to either the CFT or CBT condition. The primary outcome measure is depressive symptomatology. Secondary outcome measures are symptoms of anxiety, suicidal ideation, internalized homophobia, self-compassion, and shame and guilt proneness. Assessments will occur at pre-intervention, post-intervention, and at 3-month post-intervention.This study is an RCT to test the preliminary efficacy of an LGB-tailored compassion-focused intervention for young LGB adults with depressive symptomatology. If this intervention is efficacious, this could begin to address the substantial mental health disparities amongst sexual minorities.ACTRN12616001018404 . Prospective registration, registered 02/08/2016.