Self-compassion and the Mitigation of Negative Affect in the Era of Social Distancing

Effectiveness of Internet-delivered self-help acceptance and commitment therapy (iACT) on nurses' obsessive-compulsive symptoms and sleep quality: A randomized controlled trial with 3-month follow-up

BACKGROUND

Frontline nurses suffered unprecedented mental distress during the COVID-19 pandemic. It's essential to explore new and more accessible alternatives to improve the availability of psychological treatments. This study aimed to investigate the influence of online self-help iACT linear intervention and iACT loop intervention on sleep quality (SQ), obsessive-compulsive symptoms (OCS), and psychological flexibility (PF) in nurses.

METHODS

A randomized controlled trial was conducted at a hospital in China. 602 participants were randomly assigned to the iACT linear intervention, iACT loop intervention, or wait list control group, and required to complete the questionnaires of OCS, PF and SQ. The linear mixed effects analysis (LMM) was used to analyze the impact of the intervention on outcome variables.

RESULTS

LMM analyses demonstrated that both two intervention had significant improvement on OCS (t = -38.235, p < 0.001), PF (t = 28.156, p < 0.001), as well as SQ (t = -16.336, p < 0.001). There were significant differences between the linear group and loop group on the PF in T2 (t = -8.271, p < 0.001), T3 (t = -8.366, p < 0.001), T4 (t = -8.302, p < 0.001), with the iACT loop model (Cohen's d = 1.652) showing a slight advantage over the iACT linear model (Cohen's d = 1.134).

CONCLUSIONS

The findings indicate that two interventions positively impact OCS, PF, and SQ. Compared to the iACT linear psychotherapy model, the iACT loop model shows greater effectiveness in enhancing PF, making it helpful to promote significant improvements in psychotherapy planning.

Resilience, Coping, and the Covid-19 Pandemic Across the Globe - an Update: What Have we Learned?

The SARS-CoV-2 (COVID-19) pandemic is a mass traumatic event that has universally and indiscriminately negatively affected the world. The adverse consequences of the pandemic have globally impacted psychological health and well-being via increased stressors, such as uncertainty, health anxieties, and financial instability. During the initial months of the pandemic, we (Polizzi et al., 2020) identified coping strategies that may be well-suited to address the sequelae of the pandemic. These strategies included behavioral activation, acceptance-based coping, mindfulness practice, and loving-kindness meditation. We argued that these coping skills may foster resilience and recovery during the pandemic by generating a sense of social connection, encouraging meaning-making, and enhancing feelings of control amid uncertainty. Three years later, we update our initial suggestions by providing a narrative review that considers empirical evidence collected during the pandemic to support the utility of the previously identified coping strategies as well as additional strategies. We also discuss cross-cultural similarities and differences among these strategies and how research supports their application across diverse countries and groups. Finally, we conclude by synthesizing the literature within a regulatory flexibility framework that emphasizes flexible skill implementation with respect to sensitivity to context, coping repertoires, and feedback from the environment.

Boosting Empathy and Compassion Through Mindfulness-Based and Socioemotional Dyadic Practice: Randomized Controlled Trial With App-Delivered Trainings

BACKGROUND

Contemplative trainings have been found to effectively improve social skills such as empathy and compassion. However, there is a lack of research on the efficacy of app-delivered mindfulness-based and dyadic practices in boosting socioaffective capacity.

OBJECTIVE

The first aim of this study was to compare a novel app-delivered, partner-based socioemotional intervention (Affect Dyad) with mindfulness-based training to foster empathy and compassion for the self or others. The second aim of this study was to investigate the underlying mechanisms of these effects.

METHODS

This randomized controlled trial included socioemotional and mindfulness-based interventions and a waitlist control group, which received socioemotional training after the postintervention assessment. We used linear mixed-effects models to test intervention effects on self-report measures and an ecologically valid computer task of empathy, compassion for the self and others, and theory of mind. Moderated mediation models were used to investigate whether changes in acceptance, empathic distress, empathic listening, interoceptive awareness, and mindfulness served as underlying psychological processes of intervention effects.

RESULTS

In 218 participants (mean age 44.12, SD 11.71 years; 160/218, 73.4% female), we found all interventions to have positive effects on composite scores for compassion toward the self (βsocioemotional=.44, P<.001; βwaitlist socioemotional=.30, P=.002; βmindfulness-based=.35, P<.001) and others (βsocioemotional=.24, P=.003; βwaitlist socioemotional=.35, P<.001; βmindfulness-based=.29, P<.001). Compassion measured with the computer task did not change significantly but showed a trend toward increase only in socioemotional dyadic practice (βsocioemotional=.08, P=.08; βwaitlist socioemotional=.11, P=.06). Similarly, on the empathic concern subscale of the Interpersonal Reactivity Index, a nonsignificant trend toward increase was found in the socioemotional intervention group (βsocioemotional=.17; P=.08). Empathy significantly increased in both socioemotional groups (βsocioemotional=.16, P=.03; βwaitlist socioemotional=.35, P<.001) and the mindfulness-based group (βmindfulness-based=.15; P=.04). The measures of theory of mind did not change over time. In the mindfulness-based group, the increase in self-compassion was mediated by a decrease in empathic distress (indirect effect abmindfulness-based=0.07, 95% CI 0.02-0.14). In the socioemotional group, an increase in self-compassion could be predicted by an increase in acceptance (βsocioemotional=6.63, 95% CI 0.52-12.38).

CONCLUSIONS

Using a multimethod approach, this study shows that app-delivered socioemotional and mindfulness-based trainings are effective in fostering compassion for the self and others in self-report. Both low-dose trainings could boost behavioral empathy markers; however, the effects on behavioral and dispositional markers of compassion only trended after dyadic practice, yet these effects did not reach statistical significance. Training-related increases in self-compassion rely on differential psychological processes, that is, on improved empathic distress regulation through mindfulness-based training and the activation of a human care- and acceptance-based system through socioemotional dyadic training.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04889508; https://clinicaltrials.gov/ct2/show/NCT04889508.

Abusive supervision and cyberloafing: an investigation based on Stressor-Emotion-CWB theory

Purpose

Cyberloafing is an organization-directed counterproductive work behavior (CWB). One stream of literature deems cyberloafing to be bad for organizations and their employees, while another suggests cyberloafing is a coping response to stressful work events. Our work contributes to the latter stream of literature. The key objective of our study is to examine whether cyberloafing could be a means to cope with a stressful work event-abusive supervision, and if yes, what mediating and boundary conditions are involved. For this investigation, the authors leveraged the Stressor-Emotion-CWB theory which posits that individuals engage in CWB to cope with the negative affect generated by the stressors and that this relationship is moderated at the first stage by personality traits.

Design/methodology/approach

Using a multi-wave survey design, the authors collected data from 357 employees working in an Indian IT firm. Results revealed support for three out of the four hypotheses.

Findings

Based on the Stressor-Emotion-CWB theory, the authors found that work-related negative affect fully mediated the positive relationship between abusive supervision and cyberloafing, and work locus of control (WLOC) moderated the positive relationship between abusive supervision and work-related negative affect. The authors did not find any evidence of a direct relationship between abusive supervision and cyberloafing. Also, the positive indirect relationship between abusive supervision and cyberloafing through work-related negative affect was moderated at the first stage by the WLOC such that the indirect effect was stronger (weaker) at high (low) levels of WLOC.

Originality/value

This work demonstrates that cyberloafing could be a way for employees to cope with their abusive supervisors.

Association between self-compassion and cyber aggression in the COVID-19 context: roles of attribution and public stigma

Self-compassion is negatively associated with aggressive behaviors. However, the association between self-compassion and cyber aggression toward stigmatized people (e.g., people infected with COVID-19) has not been investigated in the COVID-19 context and the mechanism underlying this association remains underexplored. On the basis of emotion regulation theory and attribution theory, this study examined the indirect effects of self-compassion on cyber aggression toward people infected with COVID-19 through attribution and public stigma of COVID-19. Data were collected from 1162 Chinese college students (415 male, mean age = 21.61 years). Participants completed an online questionnaire including measurement of the key variables and basic demographic information. Results indicated that self-compassion was negatively associated with cyber aggression through the lower attribution of COVID-19 and lower public stigma of COVID-19. A sequential pathway from the attribution of COVID-19 to public stigma of COVID-19 was identified in the relationship between self-compassion and cyber aggression. Our findings are consistent with emotion regulation theory and attribution theory, which posit that emotion regulation strategies are associated with interpersonal mistreatment through cognitive pathways. These findings suggest that emotional self-regulation strategies can be used to reduce cyber aggression toward stigmatized people by reducing attribution and public stigma in the COVID-19 context. Self-compassion improvement could be target for the interventions aiming at alleviating public stigma and interpersonal mistreatment toward stigmatized people.

Compassion-based interventions in Asian communities: A meta-analysis of randomised controlled trials

PURPOSE

Practising compassion increases well-being and reduces depression, anxiety, and psychological distress among clinical and non-clinical populations. There is a rapid increase in compassion-based interventions within the past two decades. However, the reviews are limited to predominantly Western cultures. Therefore, this meta-analysis aimed to evaluate the literature attempting to promote and increase compassion in Asian communities.

METHOD

Eight randomised controlled trials (RCTs) conducted between 2016 to 2021 were included in the meta-analysis with data from 1012 participants across Thailand, Japan, China and Hong Kong. Effect sizes were calculated to test the efficacy of the compassion-based interventions on the self-compassion outcome. Intervention efficacy was tested by comparing the intervention groups against control groups (wait-list control and active control groups) at pre- and post-interventions.

RESULTS

Significant between-group differences in change scores were found on self-report measures of self-compassion with large effect sizes in interventions with wait-list control groups (d = .86) and small effect sizes in interventions with active-control groups (d = .19).

CONCLUSIONS

Although compassion-based interventions are heterogeneous in nature and limited in scope, there is promising evidence of improving self-compassion in Asian communities. This supports for the cross-cultural applicability of compassion-based interventions. However, research within the Asian context is limited and at an infancy stage, signifying the importance of conducting further compassion-based interventions in clinical and non-clinical groups living in the Asian communities.

The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis

BACKGROUND

After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath.

OBJECTIVE

In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews.

RESULTS

This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=-0.49; 95% CI -0.74 to -0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=-0.66; 95% CI -1.23 to -1.0; P=.02) significantly.

CONCLUSIONS

The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post-COVID-19 era.

TRIAL REGISTRATION

PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym.

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.

The Spanish Version of the State Self-Compassion Scale-Long Form (SSCS-L): A Study of Its Validity and Reliability in a Sample of Nursing Students

BACKGROUND

In nurses, self-compassion mitigates the effects of stress, burnout and compassion fatigue, and enhances empathy, compassion and well-being and quality of life. The Self-Compassion Scale is the most-used instrument. The aim of this study is to validate the Spanish version of the new developed State Self-Compassion Scale-Long (SSCS-L).

METHODS

Students of the first year of the Nursing Degree were surveyed online. Together with the SSCS-L, their levels of positive and negative affect was reported. Analyses included descriptive statistics, competitive confirmatory factor analysis, evidence on criterion-related validity and estimates of reliability.

RESULTS

The best fitting model for the SSCS-L was the one hypothesizing six-correlated factors of self-compassion: self-kindness, common humanity, mindfulness, self-judgement, isolation, and over-identification. Positive relations between the positive dimensions of self-compassion and positive affect were found, whereas there were negative relations between the positive poles of self-compassion and negative affect. Estimates of reliability were adequate, except for the dimension of over-identification.

CONCLUSIONS

Self-compassion has become a key competency for nurses. The SSCS-L is an appropriate tool to allow an adequate assessment of self-compassion in experimental contexts.

Living through the psychological consequences of COVID-19 pandemic: a systematic review of effective mitigating interventions

OBJECTIVE

This review assesses interventions and their effectiveness in mitigating psychological consequences from pandemic.

METHOD

Published English literatures were searched from four databases (Medline, PubMed, Embase and PsycINFO) from January 2020 and September 2021. A total of 27 papers with 29 studies (one paper reported three studies) met inclusion criteria. Cochrane risk-of-bias tool is applied to assess the quality of all randomised controlled trials (RCT).

RESULTS

All studies were recently conducted in 2020. Publications were from high-income (13, 44.8%), upper middle-income (12, 41.4%) and lower middle-income countries (3, 10.3%) and global (1, 3.5%). Half of the studies conducted for general population (51.7%). One-third of studies (8, 27.6%) provided interventions to patients with COVID-19 and 20.7% to healthcare workers. Of the 29 studies, 14 (48.3%) were RCT. All RCTs were assessed for risk of biases; five studies (15, 35.7%) had low risk as measured against all six dimensions reflecting high-quality study.Of these 29 studies, 26 diagnostic or screening measures were applied; 8 (30.9%) for anxiety, 7 (26.9%) for depression, 5 (19.2%) for stress, 5 (19.2%) for insomnia and 1 (3.8%) for suicide. Measures used to assess the baseline and outcomes of interventions were standardised and widely applied by other studies with high level of reliability and validity. Of 11 RCT studies, 10 (90.9%) showed that anxiety interventions significantly lowered anxiety in intervention groups. Five of the six RCT studies (83.3%) had significantly reduced the level of depression. Most interventions for anxiety and stress were mindfulness and meditation based.

CONCLUSIONS

Results from RCT studies (11%, 78.6%) were effective in mitigating psychological consequences from COVID-19 pandemic when applied to healthcare workers, patients with COVID-19 and general population. These effective interventions can be applied and scaled up in other country settings through adaptation of modes of delivery suitable to country resources, pandemic and health system context.

Online Behaviours during the COVID-19 Pandemic and Their Associations with Psychological Factors: An International Exploratory Study

This cross-sectional study aimed to explore specific online behaviours and their association with a range of underlying psychological and other behavioural factors during the COVID-19 pandemic. Eight countries (Italy, Spain, the United Kingdom, Lithuania, Portugal, Japan, Hungary, and Brazil) participated in an international investigation involving 2223 participants (M = 33 years old; SD = 11), 70% of whom were females. Participants were surveyed for specific type of Internet use severity, appearance anxiety, self-compassion, and image and use of performance-enhancing drugs (IPEDs). Results were compared cross-culturally. The mean time spent online was 5 h (SD = ±3) of daily browsing during the pandemic. The most commonly performed activities included social networking, streaming, and general surfing. A strong association between these online behaviours and appearance anxiety, self-compassion, and IPEDs use was found after adjustment for possible confounders, with higher scores being associated with specific online activities. Significant cross-cultural differences also emerged in terms of the amount of time spent online during the initial stages of the COVID-19 pandemic.