Pathways to Improving Mental Health in Compassion-Focused Therapy: Self-Reassurance, Self-Criticism and Affect as Mediators of Change

Objective: The working mechanisms of compassion-focused therapy (CFT) remain understudied. Drawing on the theoretical model underlying CFT, we examined four putative working mechanisms – self-reassurance, self-criticism, positive/negative affect – in relation to changes in well-being and psychological distress.Methods: Data of a waitlist randomised controlled trial (N = 242) investigating the effectiveness of a self-help CFT-intervention in a non-clinical sample were analysed. Using single and multiple mediation models, we assessed if changes in self-reassurance, self-criticism and positive/negative affect during the intervention (3-month interval) mediated changes in well-being and depressive/anxiety symptoms from baseline to follow-up (6-month interval) compared to the waitlist condition.Results: For each outcome, single analyses revealed that the effects of CFT were significantly mediated by self-reassurance and self-criticism. The mediating role of affect differed across outcomes. In combined models, self-reassurance emerged as a significant mediator for well-being and anxiety symptoms. Additionally, positive and negative affect were found significant mediators of the effects on depressive and anxiety symptoms, respectively.Conclusion: This study provides preliminary empirical evidence that CFT operates through cultivating self-reassurance, reducing self-criticism and regulating positive and negative affect in a non-clinical sample. To advance the development of CFT, further exploration of therapeutic change processes and their interplay is needed

Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness

Development and validation of the forms of self-criticizing / attacking and self-reassuring scale - Short form.

Studies investigating the effectiveness of compassion-focused therapy (CFT) are growing rapidly. As CFT is oriented toward helping people deal with internal processes of self-to-self-relating, having instruments to measure these processes is important. The 22-item Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) has been found a useful measure. In the present study, a 14-item short form of the FSCRS (FSCRS-SF) suited to studies requiring brief measures was developed and tested in a Dutch community sample (N = 363), and cross-validated in a sample consisting of participants in a study on the effectiveness of a guided self-help compassion training (N = 243). Confirmatory factor analysis (CFA) indicated acceptable to good fit of the FSCRS-SF items to a three-factor model. Findings regarding internal consistency were inconsistent, with Study 1 showing adequate internal consistency for all subscale scores and Study 2 demonstrating satisfactory internal consistency only for the reassured self (RS) subscale score. Furthermore, the results showed that the FSCRS-SF subscale scores had adequate test–retest reliability and satisfactory convergent validity estimates with theoretically related constructs. In addition, the FSCRS-SF subscale scores were found to be sensitive to changes in self-to-self relating over time. Despite mixed findings regarding its reliability requiring further investigation, the FSCRS-SF offers a valid and sensitive measure which shows promise as a complimentary shorter version to the original FSCRS suited to nonclinical populations. Given that the FSCRS is increasingly used as a process and outcome measure, further research on this short form in nonclinical and clinical populations is warranted.N/

Are processes in acceptance & commitment therapy (Act) related to chronic pain outcomes within individuals over time? : an exploratory study using n-of-1 designs

Acknowledgements The authors would like to thank the European Health Psychology Society for providing a grant that enabled the collaboration of the co-authors for this article. Author contributions HT designed the study, organized the data collection, carried out the statistical analyses and drafted the first version of the manuscript. DJ and MJ supervised the statistical analyses and were actively involved in writing and revising the manuscript. MVH and KS designed the study and were actively involved in writing and revising the manuscript. All authors read and approved the final manuscript.Peer reviewedPublisher PD

Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery:Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study

Background: Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. Objective: The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). Methods: We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum–Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. Results: A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum–Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients. Conclusions: This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted.</p

Intent to use a web-based psychological intervention for partners of cancer patients:Associated factors and preferences

This study examined partners of cancer patients intention to use a web-based psychological intervention, their preferences regarding its preconditions, functionalities and topics, and factors related to their intention. One hundred and sixty-eight partners completed a questionnaire about these aspects. Forty-eight percent of the partners would (maybe) make use of a web-based intervention. Partners who intended to participate were significantly younger, used the Internet more often, and perceived more caregiver strain. Most partners preferred an intervention that takes less than 1 hour/week, lasts five weeks or more, and contains information and peer support. Half of the partners would like to receive online guidance