Investigating the Influence of Self-Compassion-Focused Interventions on Posttraumatic Stress: A Systematic Review and Meta-Analysis

Compassion-Focused Therapy for the Treatment of ICD-11-Defined Complex Posttraumatic Stress Disorder

The most effective treatments for ICD-11-defined complex posttraumatic stress disorder (CPTSD) remain unknown. Further research is needed to determine whether such treatments for CPTSD are the same as or different from-or require integration with-existing gold standard treatments for posttraumatic stress disorder (PTSD). Individuals with CPTSD experience the hallmark symptoms of PTSD (i.e., reexperiencing symptoms, avoidance symptoms, and the pervasive sense of perceived threat) and pervasive disturbances in self-organization, including affective dysregulation, negative self-concept, and difficulties with interpersonal relationships. Compassion-focused therapy (CFT) is a transdiagnostic approach that was originally developed to treat shame and self-criticism. CFT helps individuals learn how to regulate their emotions, shift their emotional response style from shaming and self-critical to wise and understanding, and engage in more compassionate and rewarding patterns of relating to self and others. This article describes CFT's possible application in the treatment of CPTSD and delineates areas for future research.

Self-Compassion Interventions to Target Secondary Traumatic Stress in Healthcare Workers: A Systematic Review

Healthcare professionals' wellbeing can be adversely affected by the intense demands of, and the secondary traumatic stress associated with, their job. Self-compassion is associated with positive wellbeing outcomes across a variety of workforce populations and is potentially an important skill for healthcare workers, as it offers a way of meeting one's own distress with kindness and understanding. This systematic review aimed to synthesise and evaluate the utility of self-compassion interventions in reducing secondary traumatic stress in a healthcare worker population. Eligible articles were identified from research databases, including ProQuest, PsycINFO, ScienceDirect, Google Scholar, and EBSCO. The quality of non-randomised and randomised trials was assessed using the Newcastle-Ottawa Scale. The literature search yielded 234 titles, from which 6 studies met the inclusion criteria. Four studies reported promising effects of self-compassion training for secondary traumatic stress in a healthcare population, although these did not use controls. The methodological quality of these studies was medium. This highlights a research gap in this area. Three of these four studies recruited workers from Western countries and one recruited from a non-Western country. The Professional Quality of Life Scale was used to evaluate secondary traumatic stress in all studies. The findings show preliminary evidence that self-compassion training may improve secondary traumatic stress in healthcare professional populations; however, there is a need for greater methodological quality in this field and controlled trials. The findings also show that the majority of research was conducted in Western countries. Future research should focus on a broader range of geographical locations to include non-Western countries.

The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines

Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a "silo effect," in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.

The Effect of Daily Meditative Practices Based on Mindfulness and Self-Compassion on Emotional Distress under Stressful Conditions: A Randomized Controlled Trial

Intervention programs based on self-compassion have demonstrated their efficacy both in reducing psychological distress and increasing well-being. The goal of this study was to test the efficacy of an online intervention to increase mindfulness and self-compassion levels in a non-clinical sample in a highly stressful context: the ten weeks of lockdown imposed in the early stages of the COVID-19 pandemic. The intervention sessions consisted of thirty-minute guided meditations followed by thirty minutes of inquiry. Sixty-one participants completed two thirds of the sessions or more, and 65 individuals participated in a waiting-list (WL) control group. Self-compassion, anxiety, depression and stress levels were assessed. The analysis of pre-post results suggests that the interventions increased self-compassion levels and decreased anxiety, depression and stress levels, whereas the WL group did not show any significant changes. The emotional changes in the intervention group were associated with the increase in self-compassion. However, at follow-up, the scores of emotional distress variables returned to the initial pre-intervention scores. These data can be interpreted in line with previous results that have shown the efficacy of self-compassion-based intervention programs. Given that this efficacy was not maintained at follow-up, data are discussed according to the pervasive role of a highly stressful context and-as described in other studies-the need for regular practice to maintain the benefits obtained.

Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope

BACKGROUND

Depression is strongly implicated in drinking to cope and the development of alcohol use disorders (AUD) in women, particularly among women with a history of sexual assault victimization (SAV). Alcohol use in women is heavily stigmatized, and substance use stigma is associated with depression. This study examined the link between internalized alcohol stigma (AS) and depression and tested whether self-compassion buffered (i.e., moderated) this association in a sample of women with a history of SAV and unhealthy drinking to cope.

METHOD

Women sexual assault survivors (N = 288; 82 % White, 91.2 % Non-Hispanic, 20.2 % sexual minority) reporting unhealthy drinking (Alcohol Use Disorders Inventory Test-C ≥ 4) and drinking to cope (Drinking Coping Motives Questionnaire-Revised ≥ 2) completed online self-report surveys. Hierarchical regression analyses tested associations between internalized-AS and self-compassion with depression after controlling for covariates (age, income, education, AUD symptoms, and posttraumatic stress disorder) and then, whether self-compassion moderated the Internalized-AS and depression link.

RESULTS

Internalized-AS accounted for 1.4 % of variance in depression (p < .01); self-compassion accounted for added variance when subsequently modeled (8.2 %, p < .001). Moderation analyses revealed self-compassion to buffer the internalized-AS and depression link. Among participants reporting high levels of self-compassion, there was no association between internalized-AS and depression (p = .894).

DISCUSSION

While findings are modest, they align with the previously observed link between internalized-AS and depression and extend these findings to women with a history of SAV endorsing elevated coping motives and unhealthy drinking. Self-compassion may protect against this link, pending further research sampling greater diversity of participants and longitudinal and controlled designs.

Self-Compassion: Theory, Method, Research, and Intervention

Self-compassion refers to being supportive toward oneself when experiencing suffering or pain-be it caused by personal mistakes and inadequacies or external life challenges. This review presents my theoretical model of self-compassion as comprised of six different elements: increased self-kindness, common humanity, and mindfulness as well as reduced self-judgment, isolation, and overidentification. It discusses the methodology of self-compassion research and reviews the increasingly large number of empirical studies that indicate self-compassion is a productive way of approaching distressing thoughts and emotions that engenders mental and physical well-being. It also reviews research that dispels common myths about self-compassion (e.g., that it is weak, selfish, self-indulgent or undermines motivation). Interventions designed to increase self-compassion, such as compassion-focused therapy and mindful self-compassion, are discussed. Finally, the review considers problematic issues in the field, such as the differential effects fallacy, and considers limitations and future research directions in the field of self-compassion research.

Concurrent TMS-EEG and EEG reveal neuroplastic and oscillatory changes associated with self-compassion and negative emotions

Background/Objective

Self-compassion has a consensual relevance for overall mental health, but its mechanisms remain unknown. Using intermittent theta burst stimulation (iTBS) and concurrent transcranial magnetic stimulation-electroencephalography (TMS-EEG), this study investigated the causal relationship of the dorsolateral prefrontal cortex (DLPFC) with self-compassion and explored the changes in neuroplasticity and neural dynamics.

Method

Thirty-two healthy participants received iTBS or sham stimulation over the DLPFC, before and after which they were instructed to either use self-compassionate strategies or to be rejected in the context of social rejection and to report the level of self-compassion or negative affect. TMS-evoked potentials were evaluated as novel neuroplastic techniques with N45, P60, N100, and P180.

Results

iTBS uniquely decreased P180 amplitude measured with TMS-EEG whereby sham stimulation had no effect on neuroplasticity. In line with neuroplasticity changes, iTBS enhanced a widespread gamma band power and coherence, which correlated consistently with increased engagement in self-compassion. Meanwhile, iTBS demonstrated opposite effects on theta activity dependent on the social contexts whereby self-compassion decreased and social rejection enhanced it respectively. This unique effect of iTBS on theta activity was also supplemented by the enhancement of theta band coherence following iTBS.

Conclusions

We found a causal relationship between DLPFC and self-compassion. We also provide evidence to indicate widespread gamma activity and connectivity to correlate with self-compassion as well as the critical role of the DLPFC in modulating theta activity and negative emotions.

Posttraumatic Stress Symptoms Among Chinese College Students During the COVID-19 Pandemic: A Longitudinal Study

A longitudinal assessment of the prevalence of posttraumatic stress symptoms (PTSS) and risk factors is indispensable for further prevention and/or treatment. The longitudinal web-based survey enrolled 1,164 college students in China. Measured at two time points (February and August 2020), PTSS, demographic information, adverse childhood experiences (ACEs), resilience and self-compassion information were collected to explicate the prevalence and predictors of PTSS concurrently and over time. Results showed that although PTSS generally declined throughout the 6 months after the outbreak of COVID-19, the prevalence remained relatively high. Resilience and self-compassion negatively predicted PTSS concurrently and longitudinally. While subjective family socioeconomic status (SES) and ACEs at Wave 1 did not predict PTSS under COVID-19 at Wave 1, but both significantly predicted PTSS at Wave 2. Findings implicate potential targets for detecting and intervening on symptoms of trauma in this vulnerable population.