Testing a Low-Intensity Single-Session Self-Compassion Intervention for State Body Shame in Adult Women: A Dismantling Randomized Controlled Trial

State body shame is a risk factor for eating disorders, and self-compassion is emerging as a potentially effective treatment option in such cases. This study tested the efficacy of a brief (15-minute) self-compassion intervention in reducing state body shame. Using dismantling trial methodology, participants were randomly allocated to an active compassion condition (n = 23), an inactive control compassion condition (n = 23), or an educational control condition (n = 23). Measures of state body image and state shame were collected pre-intervention, immediately after the intervention, and a day after the intervention. Subjective units of state body shame (SUBS) were intensively measured during each invention. Self-compassion interventions were equally efficacious at protecting against deterioration of state body shame and were effective at reducing state shame compared to the educational control condition, with medium effect sizes (respectively – n_p² = .07 and n_p² = .08). Reductions in state shame were retained at follow-up. None of the interventions had an effect on body image (n_p² = .04). Findings demonstrate the clinical promise of brief self-compassion interventions, particularly as evidenced-based “homework” exercises.     

Self-Acceptance Group Therapy: A Transdiagnostic,Cognitive-Behavioral Treatment for Shame

Shame has broad importance to psychological problems. However, few interventions specifically address shame, and most of these have been designed to target shame in the context of particular disorders. Self-Acceptance Group Therapy (SAGT) was developed as a transdiagnostic shame-focused treatment, based on a cognitive-behavioral framework. SAGT is an 8-week treatment that involves psychoeducation and training in the use of cognitive and behavioral shame regulation and support-building skills in order to promote self-acceptance. After describing SAGT, the study presented used an open trial design to examine the utility of SAGT for addressing shame, self-acceptance, quality of life, and relevant psychological problems (e.g., depression, social anxiety). Twenty-four outpatients with elevated shame were assessed at pretreatment, posttreatment, and 1-month follow-up. By post-treatment, results revealed significant improvements in self-acceptance, shame, and borderline personality disorder (BPD) symptoms among treatment completers (n = 18), with all of these improvements maintained at follow-up. Additionally, significant improvements in quality of life, emotion dysregulation, depression, loneliness, and stress were observed at follow-up. Results provide preliminary support for SAGT’s utility in the treatment of shame and related pathology among diverse outpatients.     

An Internet-Based Compassion-Focused Intervention for Increased Self-Criticism: A Randomized Controlled Trial

Increased levels of self-criticism and a lack of self-compassion have been associated with the development and maintenance of a range of psychological disorders. In the current study, we tested the efficacy of an online version of a compassion-focused intervention, mindfulness-based compassionate living (MBCL), with guidance on request. A total of 122 self-referred participants with increased levels of self-criticism were randomly assigned to care as usual (CAU) or the intervention group (CAU + online intervention). Primary endpoints were self-reported depressive, anxiety and distress symptoms (DASS-21) and self-compassion (SCS) at 8 weeks. Secondary endpoints were self-criticism, mindfulness, satisfaction with life, fear of self-compassion, self-esteem, and existential shame. At posttreatment, the intervention group showed significant changes with medium to large effect sizes compared to the control group regarding primary outcomes (Cohen’s d: 0.79 [DASS] and -1.21 [SCS]) and secondary outcomes (Cohen’s ds: between 0.40 and 0.94 in favor of the intervention group). The effects in the intervention group were maintained at 6-months postrandomization. Adherence measures (number of completed modules, self-reported number of completed exercises per week) predicted postintervention scores for self-compassion but not for depressive, anxiety, and distress symptoms in the intervention group. The current study shows the efficacy of an online intervention with a transdiagnostic intervention target on a broad range of measures, including depressive and anxiety symptoms and self-compassion.     

An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility,Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program’s attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension.Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.     

The Use of Acceptance and Commitment Therapy to Promote Mental Health and School Engagement in University Students: A Multisite Randomized Controlled Trial

The aim of this multisite randomized controlled trial was to determine whether an intervention based on Acceptance and Commitment Therapy (ACT) was efficacious in improving university students’ psychological flexibility, mental health, and school engagement. Students were recruited in four Canadian universities and randomly assigned to an intervention (n = 72) or a wait-list control group (n = 72). Students in the intervention group took part in four 2.5-hour workshops during a 4-week period and were asked to do exercises at home (e.g., meditation, observation grids). Wait-list students received the intervention soon after the post measurements. MANCOVAs and ANCOVAs revealed that students in the intervention group showed greater psychological flexibility at postintervention than those in the control group. They also reported greater well-being and school engagement, and lower stress, anxiety, and depression symptoms. Taken together, results of this study suggest that an ACT-based intervention offers a valuable way to promote mental health and school engagement in postsecondary settings.     

Changes in Problematic Anger,Shame, and Disgust in Anxious and Depressed Adults Undergoing Treatment for Emotion Dysregulation

Emotion dysregulation, the pervasive difficulty managing negative emotions, is a core problem across mood and anxiety disorders. Anger, shame, and disgust are particularly problematic emotions, impacting both disorder severity and treatment outcome. We previously found that a 16-week dialectical behavior therapy skills training group (DBT-ST) was superior to an activities-based support group (ASG) in decreasing emotion dysregulation in 44 adults with high emotion dysregulation who met diagnostic criteria for an anxiety or depressive disorder. We presently examine these participants’ changes in anger, shame, disgust, and distress using self-reports collected over 6 months during and after treatment. Hierarchical linear modeling analyses show that DBT-ST was superior to ASG in decreasing anger suppression (d = 0.93) and distress (d = 1.04). Both conditions significantly reduced shame, disgust propensity, and disgust sensitivity, but neither was superior for these outcomes. The treatments did not significantly reduce anger expression. Mediation analyses suggest that condition indirectly influenced 4-month anger suppression, shame, and distress through its effect on 2-month emotion dysregulation. These findings suggest that DBT-ST is efficacious for certain problematic emotions and distress in depressed and anxious adults and that common factors may account for some, but not all, of its benefits.     

Reducing Test Anxiety in School Settings: A Controlled Pilot Study Examining a Group Format Delivery of the Attention Training Technique Among Adolescent Students

Researchers have called for the examination of test anxiety interventions that extend beyond the delivery of individual services by a trained professional. Following from conceptual models and research findings underscoring the importance of metacognitive beliefs to test anxiety, a controlled pilot study examined whether a group format delivery of the attention training technique (ATT) component of metacognitive therapy reduces test anxiety among eighth-grade students. Students completed baseline study measures and were allocated based upon class period to five sessions of ATT (n = 39) or a music listening control (n = 34) delivered within a group format during a school week. Students completed postintervention study measures on the final day of the intervention and completed follow-up study measures approximately 3 weeks following the intervention. As predicted, students receiving ATT reported less postintervention test anxiety than the control when they held stronger baseline metacognitive beliefs about worry. The patterns of findings held at the follow-up and when specifically examining the cognitive (i.e., worry) dimension of test anxiety. Study results suggest that ATT may be a viable test anxiety intervention for students holding heightened metacognitive beliefs about worry. Future directions are discussed.     

Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression

A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants’ available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η² = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η² = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η² = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.     

The shame of being undone by illness and the power of support through the body of Christ

This paper examines shame that arises from living with a body that has been undone by cancer or other serious illness. It draws on first-person narratives and social-scientific studies of cancer patients to explore how bodies undone by illness often cease to conform to cultural standards of health as well as gendered expectations of bodies, and how experiences of shame arise from those shifts in how sick bodies appear and perform. Analysis of narratives by and qualitative data about those who are seriously ill also reveals how the undoing of the body by illness often precipitates an undoing of one's sense of self that leads to experiences of shame over an inability to fill roles and expectations in ways that were possible in life before serious illness. The paper then utilizes biblical and theological resources to explore ways religious communities can make space for those living with serious illness to lament what it's like to be undone by illness, to hold them up amid their experiences of vulnerability through public lament and acts of accompaniment, and to affirm their worth in the eyes of God and in the body of Christ.     

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12 months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n = 69) or a wait-list condition (n = 70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d = 1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82 ≤ d ≤ 1.11). In the treatment group significant improvement was still observed for all measures 1 year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.     

Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study

Objective: Neuroticism, a characteristic associated with increased stress vulnerability and the tendency to experience distress, is strongly linked to risk of different forms of psychopathology. However, there are few evidence-based interventions to target neuroticism. This pilot study investigated the efficacy and acceptability of mindfulness-based cognitive therapy (MBCT) compared with an online self-help intervention for individuals with high levels of neuroticism. The MBCT was modified to address psychological processes that are characteristic of neuroticism. Method: Participants with high levels of neuroticism were randomized to MBCT (n = 17) or an online self-help intervention (n = 17). Self-report questionnaires were administered preintervention and again at 4 weeks postintervention. Results: Intention-to-treat analyses found that MBCT participants had significantly lower levels of neuroticism postintervention than the control group. Compared with the control group, the MBCT group also experienced significant reductions in rumination and increases in self-compassion and decentering, of which the latter two were correlated with reductions in neuroticism within the MBCT group. Low drop-out rates, high levels of adherence to home practice, and positive feedback from MBCT participants provide indications that this intervention may be an acceptable form of treatment for individuals who are vulnerable to becoming easily stressed. Conclusions: MBCT specifically modified to target neuroticism-related processes is a promising intervention for reducing neuroticism. Results support evidence suggesting neuroticism is malleable and amenable to psychological intervention. MBCT for neuroticism warrants further investigation in a larger study.     

Factors Impacting the Mental Health of the Caregivers of Children with Asthma in China: Effects of Family Socioeconomic Status,Symptoms Control,Proneness to Shame,and Family Functioning

Caregiver mental health is widely considered to be an important factor influencing children's asthma symptoms. The present study aimed to examine key factors that contribute to caregiver mental health in pediatric asthma with a Chinese sample. Two hundred participants reported their family socioeconomic status (SES), proneness to shame, asthma symptoms control of their child, family functioning, and their depression and anxiety symptoms. Results suggested that low family SES, low family functioning, and a high level of shame proneness were associated with high levels of anxiety and depression for caregivers. Family functioning mediated the effects of SES and shame on caregiver mental health and also moderated the effects of SES and shame on caregiver depression. This study highlights the importance of reducing experience of shame and enhancing family functioning in families affected by pediatric asthma.     

Self-Objectification, Self-Esteem, and Gender: Testing a Moderated Mediation Model

The purpose of the present research was to test the mediating roles of body shame and appearance anxiety in the relation between self-surveillance and self-esteem; and to investigate whether gender (male, female) and stereotypical gender roles (masculinity, femininity) moderated the proposed mediation model. Canadian undergraduate university men and women (n?=?198) completed measures of self-surveillance, gender, gender roles, body shame, appearance anxiety, and self-esteem. Regression analyses demonstrated that greater self-surveillance predicted lower self-esteem, and this relation was fully mediated by body shame and appearance anxiety. With the exception of masculinity interacting with self-surveillance to predict body shame and appearance anxiety, neither gender nor stereotypical gender roles moderated the proposed paths. Implications are discussed.     

The relationship between shame and guilt: cultural comparisons between Ireland and the United Arab Emirates

The current study examines whether proneness to shame and guilt is related to the cultural dimensions of collectivism and individualism. Two groups of participants from Ireland (n?=?120) and the United Arab Emirates (UAE) (n?=?115) completed measures assessing collectivism, individualism, and shame and guilt proneness. Results indicated that both samples displayed similar levels of individualism and collectivism. The UAE sample reported significantly higher levels of guilt proneness and shame proneness characterised by negative self-evaluation. In contrast, the Irish sample displayed significantly higher levels of shame characterised by withdrawal tendencies. Guilt was positively correlated with individualism, but shame was not correlated with either scores on collectivism or individualism. Young Arab women appear to experience higher levels of guilt and shame characterised by negative self-evaluation in comparison to their Irish counterparts who displayed higher levels of guilt proneness.     

Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial

Objective

The current study examined the efficacy of an early intervention based on acceptance and commitment therapy (ACT) for depressive symptomatology. The ACT intervention is aimed at increasing the acceptance of negative thoughts and emotions and living a mindful and value-based life.

Method

Adults with mild to moderate depressive symptomatology were randomly assigned to the ACT intervention (n = 49) or to a waiting list (n = 44). The mean age of the participants was 49 years. The majority of the participants was female and of Dutch origin. All the participants completed measures before and after the intervention, as well as three months later at follow-up to assess depression (CES-D), anxiety (HADS-A), fatigue (CIS), alcohol use and acceptance (AAQ-II).

Results

The ACT intervention led to statistically significant reduction in depressive symptomatology (Cohen’s d = .60). These reductions were maintained at the three-month follow-up. Also significant reductions in anxiety and fatigue were observed. Moreover, mediational analysis showed that the improvement of acceptance during the intervention mediated the effects of the intervention on depressive symptomatology at follow-up.

Conclusion

These findings suggest that an early intervention based on ACT, aimed at increasing acceptance, is effective in reducing depressive symptomatology.     

Assessing the Role of Body Image Coping Strategies as Mediators or Moderators of the Links Between Self-Objectification, Body Shame, and Well-Being

We examined self-objectification in relation to well-being, and the potential moderating versus mediating role of body image coping strategies (appearance fixing, avoidance, positive rational acceptance). Undergraduate women from southern Ontario, Canada (Sample 1, n?=?104; Sample 2, n?=?314) completed measures of depression, disordered eating attitudes, subjective well-being, and body-image coping. Self-objectification was related to greater depression, disordered eating attitudes, and lower subjective well-being. A two-stage mediation model was supported: Body shame and body image coping strategies (appearance fixing and avoidance) partially mediated the associations between self-objectification and outcomes; appearance fixing and avoidance partially mediated the associations between body shame and outcomes. Body image coping strategies did not moderate any of the relations between body shame and outcomes.     

Be a Mom,a Web-Based Intervention to Prevent Postpartum Depression: Results From a Pilot Randomized Controlled Trial

Be a Mom is a self-guided web-based intervention, grounded in cognitive behavioral therapy, delivered to postpartum women to prevent persistent postpartum depression [PPD] symptoms. We aimed to evaluate Be a Mom in terms of its preliminary efficacy, feasibility, and acceptability. A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention (Be a Mom) or to the waiting-list control group. Participants in both groups completed baseline (T1) and postintervention (T2) assessments. The 194 women presenting risk factors/early-onset PPD symptoms were allocated to the intervention (n = 98) or to the control (n = 96) group. A significant Time × Group interaction effect was found for both depressive and anxiety symptoms, with women in the intervention group presenting a larger decrease in symptoms from T1 to T2 (p < .05). Less than half of the women (41.8%) completed Be a Mom. Most women (71.4%) would use Be a Mom again if needed. Results provide preliminary evidence of the Be a Mom’s efficacy, acceptability and feasibility, although further research is needed to establish Be a Mom as a selective/indicative preventive intervention for persistent PPD.     

Adaptive working memory training can reduce anxiety and depression vulnerability in adolescents

Adolescents can be at heightened risk for anxiety and depression, with accumulating research reporting on associations between anxiety and depression and cognitive impairments, implicating working memory and attentional control deficits. Several studies now point to the promise of adaptive working memory training to increase attentional control in depressed and anxious participants and reduce anxiety and depression symptoms, but this has not been explored in a non‐clinical adolescent population. The current study explored the effects of adaptive dual n‐back working memory training on sub‐clinical anxiety and depression symptomology in adolescents. Participants trained on either an online adaptive working memory task or non‐adaptive control task for up to 20 days. Primary outcome measures were self‐reported anxiety and depression symptomology, before and after intervention, and at 1‐month follow‐up. Self‐reported depression (p = 0.003) and anxiety (p = 0.04) decreased after training in the adaptive n‐back group relative to the non‐adaptive control group in the intention‐to‐treat sample (n = 120). These effects were sustained at follow‐up. Our findings constitute proof of principle evidence that working memory training may help reduce anxiety and depression vulnerability in a non‐clinical adolescent population. We discuss the findings’ implications for reducing risk of internalizing disorders in youth and the need for replication.     

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS

Symptoms of depression negatively impact on mother?infant relationships and child outcomes. We evaluated a novel, 10‐session mother?infant therapeutic playgroup—Community HUGS (CHUGS)—which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother?infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait‐list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self‐Efficacy subscale; J. Gibaud‐Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self‐efficacy, p < .001, all showed improvements, as did observer‐rated mother?infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait‐list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self‐efficacy, depression, anxiety, stress, and mother?infant interactions that supported the program's acceptability and the utility of further rollout.