Effect of a Compassion Cultivation Training Program for Caregivers of People With Mental Illness in Denmark: A Randomized Clinical Trial

Invitation to Self-Compassion: Reshaping Burden of Care in the Light of Self-Compassion Training Given to Relatives of Patients Hospitalised in Palliative Care

AIM

This study was conducted to investigate the effects of self-compassion training given to the relatives of patients hospitalised in the palliative care unit on the care burden and self-compassion of patient relatives.

METHOD

The study is a randomised, controlled experimental study in pretest-posttest design. The study was conducted between February 2024 and June 2024 with the relatives of the patients who received care and treatment in the palliative care unit of a hospital in eastern Turkey. The study was completed with 30 patient relatives in the intervention group and 32 patient relatives in the control group. The patient relatives in the intervention group received 40-50 min of self-compassion training for 8 weeks. No intervention was given to the control group. Personal Information Form, Self-Compassion Scale, and Caregiver Burden Scale were used to collect the data.

RESULTS

While there was no significant difference in the total mean scores of the caregiver burden scale and self-compassion scale of the intervention group before the intervention compared to the control group (p > 0.05), a significant difference was found after the intervention (p < 0.05). When the regression coefficients were analysed, it was found that self-compassion training negatively affected the total mean score of the caregiver burden scale and explained 55% of its variance, while it positively affected the total mean score of the self-compassion scale and explained 55% of its variance.

CONCLUSION

This study shows that self-compassion training given to the relatives of patients hospitalised in the palliative care unit is effective in terms of reducing the burden of care and increasing their self-compassion. Relatives of patients who received self-compassion training experienced a decrease in their care burden and an increase in their self-compassion. These findings emphasise the importance of self-compassion training in supporting the relatives of patients in palliative care.

Compassion-Based Intervention Program for Enhancing Coping Patterns Among Family Caregivers of Patients With Bipolar Disorder

Introduction

Bipolar disorder is a long-term, complicated mental illness that affects not only the patient's mental health, but also their family's psychological health and coping strategies.

Objective

This study aimed to evaluate the effects of a compassion-based intervention program on coping patterns among family caregivers of patients with bipolar disorder.

Methods

From June 2023 to March 2024, a study utilizing a one-group pre- and postinterventional design evaluated 50 family caregivers of patients with bipolar disorder. The study was conducted in an outpatient clinic at the Institute of Psychiatry affiliated with Ain Shams University Hospitals, Cairo, Egypt. The program consisted of 16 consecutive sessions, each lasting approximately 45 to 60 min. Researchers used a predesigned questionnaire to collect data pre- and postintervention to assess the sociodemographic data, self-compassion scale, and coping strategies inventory.

Results

Prior to the compassion intervention program, the study found that 62% of the evaluated family caregivers had low self-compassion; however, after the compassion intervention program, a highly significant improvement was observed, with 54% having high self-compassion (p < .01). Likewise, in the compassion intervention program, the study revealed that 60% of the family caregivers had a high use of disengagement coping patterns; however, in the postcompassion intervention program, a highly significant improvement was observed, with 64% having a high use of engagement coping patterns (p < .01).

Conclusion

The Compassion-Based Intervention Program has a positive effect on enhancing coping patterns and self-compassion among family caregivers of patients with bipolar disorder. Therefore, psychiatric nurses and mental health practitioners should collaborate in designing holistic caregiver support strategies that incorporate self-compassion techniques alongside traditional therapeutic approaches.

Web-Based Compassion Interventions for Family Caregivers' Mental Well-Being: A Systematic Review and Meta-Analysis

OBJECTIVES

To assess the effectiveness of web-based compassion interventions on the mental well-being of family caregivers.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Randomized controlled trials of web-based compassion intervention for family caregivers.

METHODS

MEDLINE, Embase, PsycINFO, Web of Science, Cochrane Library, and Proquest were searched from database inception until manuscript submission date. Eligible studies included family caregivers participating in web-based compassionate interventions with reported mental wellness indicators, such as self-compassion. Two independent researchers conducted a literature review, extracted data, and assessed the quality of each study using the risk of bias 2 tool. Random effects meta-analysis was performed to pool the data, followed by subgroup analyses, sensitivity analyses, and Egger's tests.

RESULTS

Of 1095 studies evaluated, 8 randomized controlled trials (encompassing 1978 participants) were included, with 75% exhibiting low risk of bias and high-quality evidence. Meta-analysis results indicated positive effects of web-based compassion interventions on family caregivers' self-compassion [standardized mean difference (SMD), 0.33; 95% CI, 0.08-0.58; P = .009] and mindfulness (SMD, 0.46; 95% CI, 0.03-0.90; P = .04). These interventions also demonstrated a positive impact on reducing stress (SMD, -0.32; 95% CI, -0.59 to -0.04; P = .02) and anxiety (SMD, -0.28; 95% CI, -0.47 to -0.09; P = .003). Subgroup analyses highlighted superior self-compassion outcomes for caregivers supporting individuals with mental illness and cancer compared with those caring for individuals with Alzheimer's disease. Interventions lasting ≥8 weeks were the most common and effective.

CONCLUSIONS AND IMPLICATIONS

Web-based compassion interventions benefit family caregivers by enhancing self-compassion, mindfulness, and reducing anxiety and stress. More well-designed studies are suggested for future clinical applications.

The effect of psilocybin on empathy and prosocial behavior: a proposed mechanism for enduring antidepressant effects

Psilocybin is a serotonergic psychedelic shown to have enduring antidepressant effects. Currently, the mechanism for its enduring effects is not well understood. Empathy and prosocial behavior may be important for understanding the therapeutic benefit of psilocybin. In this article we review the effect of psilocybin on empathy and prosocial behavior. Moreover, we propose that psilocybin may induce a positive feedback loop involving empathy and prosocial behavior which helps explain the observed, enduring antidepressant effects.

A randomized controlled trial of a targeted support program for informal caregivers in adult psychiatry

Background

The importance of informal caregivers for persons with severe mental illness has been demonstrated. However, this role may cause a high care burden that considerably affects caregiver health. The Ensemble program is a five-session brief individual intervention designed to support informal caregivers. This trial aimed to assess the efficacy of the program versus SAU (support as usual) for participants with a high care burden.

Methods

A single-center randomized controlled trial including 149 participants was conducted. Caregivers in the intervention arm participated in the Ensemble program. The effects of the intervention were assessed using mixed models for repeated measures analysis of variance on improvements in informal caregivers' psychological health status, optimism levels, burden scores, and quality of life at three time points (T0 = pretest; T1 = posttest at 2 months, and T2 = follow-up at 4 months).

Results

Analysis of the Global Psychological Index showed no significant effect at the two endpoints in favor of the Ensemble group. However, the Brief Symptom Inventory-Positive Symptom Distress Index was significantly lower at the two-month follow-up. A significant reduction in burden on the Zarit Burden Interview was observed post-intervention, along with an increase in optimism levels on the Life Orientation Test-Revised at follow-up in the Ensemble group. No significant differences were observed in quality of life. Clinical improvements in both psychological health status and burden levels were also identified.

Conclusion

The Ensemble program offers an inclusive approach based on a recovery perspective that significantly reduces symptom distress and burden and increases optimism among informal caregivers.Clinical trial registration: https://clinicaltrials.gov/, NCT04020497.

A compassion-based program to reduce psychological distress in medical students: A pilot randomized clinical trial

OBJECTIVES

Physicians and medical students are subject to higher levels of psychological distress than the general population. These challenges have a negative impact in medical practice, leading to uncompassionate care. This pilot study aims to examine the feasibility of Compassion Cultivation Training (CCT) to reduce psychological distress and improve the well-being of medical students. We hypothesize that the CCT program, as compared to a waitlist control group, will reduce psychological distress (i.e., stress, anxiety, and depression) and burnout symptoms, while improving compassion, empathy, mindfulness, resilience, psychological well-being, and emotion-regulation strategies after the intervention. Furthermore, we hypothesize that these improvements will be maintained at a two-month follow-up.

METHODS

Medical students were randomly assigned to an 8-week CCT or a Waitlist control group (WL). They completed self-report assessments at pre-intervention, post-intervention, and a 2-month follow-up. The outcomes measured were compassion, empathy, mindfulness, well-being, resilience, emotional regulation, psychological distress, burnout, and COVID-19 concern. Mixed-effects models and Reliable Change Index were computed.

RESULTS

Compared with WL, CCT showed significant improvements in self-compassion, mindfulness, and emotion regulation, as well as a significant decrease in stress, anxiety, and emotional exhaustion component of burnout. Furthermore, some of these effects persisted at follow-up. No adverse effects of meditation practices were found.

CONCLUSIONS

CCT enhanced compassion skills while reducing psychological distress in medical students, this being critical to preserving the mental health of physicians while promoting compassionate care for patients. The need for institutions to include this type of training is also discussed.

'It's like they're learning what it is for the very first time': Clinician's accounts of self-compassion in clients whose parents experience mental illness

OBJECTIVES

Individuals who have a parent with mental illness are more likely to experience mental illness than their contemporaries. As such, it is valuable to examine potential psychological resources, which might assist these individuals to experience good mental health throughout their lifespan. We aimed to learn how clinicians perceive self-compassion, and how it can be incorporated into therapy with clients who have parents with mental illness.

DESIGN

A qualitative interview design was employed to explore clinicians' perspectives and experiences.

METHODS

Eight mental health clinicians experienced in working with clients who have parents with mental illness were interviewed. Interpretative phenomenological analysis was used to establish themes representing the clinicians' perspectives and experiences of incorporating self-compassion into their work.

RESULTS

This study found that clinicians were generally positive about incorporating self-compassion into interventions with clients who are children of parents with mental illness. The participants noted barriers to self-compassion for these clients, namely a poor sense of self and divided loyalty between self and family. Participants recommended taking time and care, building rapport and involving others when cultivating self-compassion with those who have parents with mental illness.

CONCLUSIONS

This group of clinicians viewed self-compassion as relevant to clients whose parents have mental illness and believe it can be introduced therapeutically in various ways. Suggestions are made for tailoring self-compassion training to the needs and experiences of this group.

Health workforce governance for compassionate and respectful care: a framework for research, policy and practice

The progressive realisation of universal health coverage requires that health services are not only available and accessible, but also that they are rendered to the population in an acceptable, compassionate and respectful manner to deliver quality of care. Health workers’ competencies play a central role in the provision of compassionate and respectful care (CRC); but health workers’ behaviour is also influenced by the policy and governance environment in which they operate. The identification of relevant policy levers to enhance CRC therefore calls for actions that enable health workers to optimise their roles and fulfil their responsibilities.

This paper aims at exploring the health workforce policy and management levers to enable CRC. Through an overview of selected country experiences, concrete examples are provided to illustrate the range of available policy options. Relevant interventions may span the individual, organisational, or system-wide level. Some policies are specific to CRC and may include, among others, the inclusion of relevant competencies in preservice and in-service education, supportive supervision and accountability mechanisms. Other relevant actions depend on a broader workforce governance approach, including policies that target health workforce availability, distribution and working conditions, or wider system -level factors, including regulatory and financing aspects.

The selection of the appropriate system-wide and CRC-specific interventions should be tailored to the national and operational context in relation to its policy objectives and feasibility and affordability considerations. The identification of performance metrics and the collation and analysis of required data are necessary to monitor effectiveness of the interventions adopted.

The effect of mental health interventions on psychological distress for informal caregivers of people with mental illness: A systematic review and meta-analysis

INTRODUCTION

Informal caregivers of people with a mental illness are at increased risk of developing depression, anxiety, and stress, so preventive interventions are needed.

METHOD

The review was reported in PROSPERO (ID: CRD42018094454). The PsycINFO, PubMed, and Scopus databases were searched in June 2019. The Cochrane Risk of Bias and Jadad scale scores were used to assess study quality. Inclusion criteria were: RCTs of informal caregiver interventions regardless of the care receiver's mental illness and intervention modality. Interventions should be compared to a waitlist, treatment as usual or active control, taught in real-time by a mental health professional, include an outcome measure on psychological distress, and published in a peer-reviewed journal article in English. RCTs were excluded if the intervention was given in dyads (caregiver + care receiver), limited to the provision of respite care where the patient sample included a mix of both physical and psychological illnesses, unpublished, not peer-reviewed, study protocols, or dissertations.

RESULTS

A total of 2,148 studies were identified; of these, 44 RCT studies met the inclusion criteria, and 31 had sufficient data to conduct a meta-analysis including subgroup analysis (N = 1,899). The systematic review showed that thirty-one out of the 44 RCTs had an effect of the intervention on decreasing psychological distress. The results of the meta-analysis, which included informal caregiver interventions, compared to waitlist, treatment as usual, or active control, regardless of care-receiver mental illness or intervention modality showed a small effect of -0.32 (95% CI -0.53 to -0.11). The heterogeneity of the included studies was high (I ² = 78). The subgroup analysis included manualized interventions lasting at least 8 weeks and the subgroup analysis that included an active control showed a small effect and low heterogeneity. Lack of active control and long-term follow-up is a limitation of most of the studies.

CONCLUSION

The evidence supports that several interventions improve the mental health of caregivers. Manualized interventions ≥ 8 weeks with active participation are most effective. Future RCTs should improve methodology, and research should investigate which intervention modality is most effective for what kind of caregiver. Future research should clearly specify what the included intervention components are, use longer follow-up times, and conduct mediational analyses to better understand what mechanisms create the effect of an intervention.

SYSTEMATIC REVIEW REGISTRATION

Identifier: CRD42018094454.

Neurocognitive mechanisms underlying improvement of prosocial responses by a novel implicit compassion promotion task

Compassion is closely associated with prosocial behavior. Although there is growing interest in developing strategies that cultivate compassion, most available strategies rely on effortful reflective processes. Furthermore, few studies have investigated neurocognitive mechanisms underlying compassion-dependent improvement of prosocial responses. We devised a novel implicit compassion promotion task that operates based on association learning and examined its prosocial effects in two independent experiments. In Experiment 1, healthy adults were assigned to either the compassion or control group. For the intervention task, the compassion group completed word fragments that were consistently related to compassionate responses toward others; in contrast, the control group completed word fragments related to emotionally neutral responses toward others. Following the intervention task, we measured attentional biases to fearful, sad, and happy faces. Prosocial responses were assessed using two measures of helping: the pen-drop test and the helping intentions rating test. In Experiment 2, independent groups of healthy adults completed the same intervention tasks used in Experiment 1. Inside a functional MRI scanner, participants rated empathic care and distress based on either distressful or neutral video clips. Outside the scanner, we assessed the degree of helping intentions toward the victims depicted in the distressful clips. The results of Experiment 1 showed that the compassion promotion task reduced attentional vigilance to fearful faces, which in turn mediated a compassion promotion task-dependent increase in helping intentions. In Experiment 2, relative to the control group, the compassion group showed reduced empathic distress and increased activity in the medial orbitofrontal cortex in response to others' suffering. Furthermore, increased functional connectivity of the medial orbitofrontal and inferior parietal cortex, predicted by reduced empathic distress, explained the increase in helping intentions. These results suggest the potential of implicit compassion promotion intervention to modulate compassion-related and prosocial responses as well as highlight the brain activation and connectivity related to these responses, contributing to our understanding of the neurocognitive mechanisms underlying compassion-dependent prosocial improvement.

Mediators for the Effect of Compassion Cultivating Training: A Longitudinal Path Analysis in a Randomized Controlled Trial Among Caregivers of People With Mental Illness

Background: There is a paucity of research on mediators of change, within compassion training programs. The aim was to investigate the mediators, of an 8-week compassion cultivation training (CCT) program, on the effect of psychological distress on caregivers of people with a mental illness. Method: Longitudinal path models in a randomized controlled trial (RCT). One hundred ninety-two participants were assessed for eligibility, and 161 participants were included into the trial and randomized. The main outcome was psychological distress measured by the Depression, Anxiety and Stress scale at 6 months. Mediators included self-compassion (SC), mindfulness (FM), emotion regulation (ER), emotion suppression (ES), and cognitive reappraisal (CR). Baseline, post, and 3- and 6-month follow-up measurements were collected. Results: The mediated effects for CCT are as follows: depression at 6 months: SC: -1.81 (95% CI: -3.31 to -0.31); FM: -1.98 (95% CI: -3.65 to -0.33); ER: -0.14 (95% CI: -1.31 to 1.02); anxiety at 6 months: SC: -0.71 (95% CI: -1.82 to 0.40); FM: -1.24 (95% CI: -2.39 to -0.09); ER: 0.18 (95% CI: -1.04 to 1.40); stress at 6 months: SC: -1.44 (95% CI: -2.84 to -0.05); FM: -2.17 (95% CI: -3.63 to -0.71); ER: -0.27 (95% CI: -1.51 to 0.98). Conclusion: Mindfulness and self-compassion are important components in reducing psychological distress experienced by informal caregivers of people with a mental illness. Results contribute to the knowledge about the underlying mechanisms of CCT.