Self-Compassion and Body Dissatisfaction in Women: A Randomized Controlled Trial of a Brief Meditation Intervention

Abstract

Body dissatisfaction is a major source of suffering among women of all ages. One potential factor that could mitigate body dissatisfaction is self-compassion, a construct that is garnering increasing research attention due to its strong association with psychological health. This study investigated whether a brief 3-week period of self-compassion meditation training would improve body satisfaction in a multigenera-tional group of women. Participants were randomized either to the meditation intervention group (N=98; M age=38.42) or to a waitlist control group (N=130; M age=36.42). Results sug-gested that compared to the control group, intervention par-ticipants experienced significantly greater reductions in body dissatisfaction, body shame, and contingent self-worth based on appearance, as well as greater gains in self-compassion and body appreciation. All improvements were maintained when assessed 3 months later. Self-compassion meditation may be a useful and cost-effective means of improving body image in adult women.

Full text

ORIGINAL PAPER
Self-Compassion and Body Dissatisfaction in Women:
A Randomized Controlled Trial of a Brief Meditation
Intervention
Ellen R. Albertson &Kristin D. Neff &
Karen E. Dill-Shackleford
#Springer Science+Business Media New York 2014
Abstract Body dissatisfaction is a major source of suffering
among women of all ages. One potential factor that could
mitigate body dissatisfaction is self-compassion, a construct
that is garnering increasing research attention due to its strong
association with psychological health. This study investigated
whether a brief 3-week period of self-compassion meditation
training would improve body satisfaction in a multigenera-
tional group of women. Participants were randomized either to
the meditation intervention group (N=98; M age=38.42) or to
a waitlist control group (N=130; Mage=36.42). Results sug-
gested that compared to the control group, intervention par-
ticipants experienced significantly greater reductions in body
dissatisfaction, body shame, and contingent self-worth based
on appearance, as well as greater gains in self-compassion and
body appreciation. All improvements were maintained when
assessed 3 months later. Self-compassion meditation may be a
useful and cost-effective means of improving body image in
adult women.
Keywords Self-compassion .Meditation .Mindfulness .
Body image .Body shame .Body dissatisfaction .Body
appreciation
Introduction
Self-compassion—a construct derived from Buddhist psy-
chology (Brach, 2003;Salzberg,1997)—is garnering increas-
ing research attention due to its strong association with mental
health (see Barnard and Curry 2011 for a review). Neff
(2003a,b) has proposed that self-compassion entails being
moved by one’s own suffering and treating oneself in a caring
and empathetic way—just as one would treat a good friend.
Self-compassion is relevant to all experiences of suffering,
including those caused by perceived flaws, personal inade-
quacies, failures, or emotionally distressing life events.
More specifically, self-compassion is defined as being
comprised of three interconnected components: self-
kindness, common humanity, and mindfulness (Neff,
2003b). Self-kindness refers to the tendency to be caring and
understanding toward the self rather than harshly judgmental.
Rather than attacking and berating oneself for personal short-
comings, the self is offered warmth, comfort, and uncondi-
tional acceptance. The sense of common humanity entailed in
self-compassion involves recognizing that all people are im-
perfect, fail, make mistakes, and experience serious life chal-
lenges, rather than feeling isolated by the experience of im-
perfection. Mindfulness in the context of self-compassion
involves being aware of one’s painful experiences in a bal-
anced way that neither ignores nor amplifies painful thoughts
and emotions. It is necessary to be mindful of one’s suffering
in order to be able to extend compassion towards the self. At
the same time, it is important to pay attention in an equilibrat-
ed way that does not involve “over-identification,”i.e., being
carried away by a dramatic storyline that exaggerates impli-
cations for self-worth (Neff 2003b).
Research indicates that self-compassionate individuals are
psychologically healthier than those who lack self-
compassion. For instance, a recent meta-analysis by MacBeth
and Gumley (2012) documented a large effect size for the
relationship between self-compassion and common expres-
sions of psychopathology such as depression, anxiety, and
stress. Self-compassion is also linked to positive psychologi-
cal strengths such as happiness, emotional intelligence, opti-
mism, wisdom, curiosity, and personal initiative (Heffernan
et al. 2010; Hollis-Walker and Colosimo 2011;Neffetal.
E. R. Albertson (*):K. E. Dill-Shackleford
Department of Psychology, Fielding Graduate University,
Santa Barbara, CA, USA
e-mail: cooktwo@comcast.net
K. D. Neff
Department of Educational Psychology, University of Texas
at Austin, Austin, TX, USA
Mindfulness
DOI 10.1007/s12671-014-0277-3

2007). Self-compassion is associated with less rumination, per-
fectionism, and fear of failure (Neff 2003a;Neffetal.2005), as
well as greater capacity to effectively deal with stressors such as
academic pressure (Neely et al. 2009), divorce (Sbarra et al.
2012), and chronic pain (Costa and Pinto-Gouveia 2011).
As an emotional regulatory strategy that teaches individ-
uals how to accept themselves despite their imperfections,
self-compassion has clear potential for alleviating the suffer-
ing associated with body dissatisfaction. Body dissatisfaction
can be defined as a negative evaluation of one’sbodythat
involves a perceived discrepancy between an individual’s
assessment of her actual and ideal body (Cash and
Szymanski 1995). Self-compassion may also decrease body
shame—the feeling one is a bad person if sociocultural body
standards are not met (McKinley 2006). Body dissatisfaction
and body shame are so prevalent in females in Western soci-
eties that the phenomenon has been described as “normative
discontent”(Rodin et al. 1985; Striegel-Moore and Franko
2002). Women of all ages experience serious cognitive, affec-
tive, and behavioral symptoms triggered by body dissatisfac-
tion (Grogan, 2008), which persist across the lifespan
(Tiggemann 2004; Tiggemann and Lynch 2001;Grippoand
Hill 2008; Lewis and Cachelin 2001) and appears to be
resistant to a variety of interventions (Pearson et al. 2012).
Body dissatisfaction and body shame are regarded as cen-
tral to the development of eating pathology (American
Psychiatric Association, 2000) and are also associated with
higher levels of depression and anxiety (Szymanski and
Henning 2007; Van den Berg et al. 2007), lower self-esteem
(Grossbard et al. 2009), poorer quality of life (Ganem et al.
2009), decreased physical activity (Ransdell et al. 1998), and
other unhealthy behaviors such as smoking (King et al. 2005).
As Gilbert and Miles (2002)) summarized, “When people
experience their physical bodies as in some way unattractive,
undesirable and a source of a ‘shamed self’they are at risk of
psychological distress and disorders”(p. 3).
Self-compassion is likely to lessen body dissatisfaction among
women for several reasons. First, being kind, gentle, and under-
standing towards oneself rather than harshly judgmental, directly
counters the very root of body dissatisfaction—the tendency to
criticize rather then accept one’s body as it is. Similarly, the sense
of common humanity entailed by self-compassion should help
women consider their physical appearance from a broad, inclu-
sive perspective that mitigates body dissatisfaction and associated
feelings of body shame. The element of mindfulness that is
central to self-compassion should also be a mitigating factor by
helping women relate to their painful thoughts (e.g., my body is
unattractive) and emotions (e.g., I feel too fat to be worthy of
love) in a balanced way that avoids fixating on or overidentifying
with disliked body characteristics.
Correlational research suggests that self-compassion is sig-
nificantly associated with body image concerns. Among
breast cancer survivors, for instance, trait levels of self-
compassion mediated the link between body image distur-
bance and psychological distress (Przezdziecki et al. 2012).
Self-compassion has also been associated with less body dis-
satisfaction, body shame, social physique anxiety, and objecti-
fied body consciousness (Mosewich et al. 2011). In addition, a
recent study of university women found that higher levels of
self-compassion predicted fewer body concerns, body preoc-
cupation, and weight worries (Wasylkiw et al. 2012).
In addition to buffering the negative effects of body dissat-
isfaction and shame, self-compassion may also enhance
women’s abilities to appreciate their bodies (Ferreira et al.
2013). Body appreciation refers to the extent to which women
like, accept, and respect their bodies despite weight, shape,
and imperfections, and is a positive psychological strength
that has been linked to optimism and life satisfaction (Avalos
et al. 2005). Because self-compassion is associated with pos-
itive mind states such as optimism, life satisfaction and grat-
itude (Breen et al. 2010;Neff2003a;Neffetal.2008;Neff
et al. 2007; Shapira and Mongrain 2010), it may also enhance
a sense of appreciation and respect for one’sbodyasitis.
One way in which self-compassion may improve body
image is by offering women an alternative way of valuing
themselves. Women living in Western culture are taught that
physical beauty is one of their most important features. In fact,
women’s self-esteem is largely contingent upon meeting so-
cietal standards of ideal beauty (Harter 1999). If they do not
meet these standards, their sense of self-worth suffers. Like
self-esteem, self-compassion is a significant source of positive
self-regard. While self-esteem is contingent on success in
valued domains such as appearance or social approval
(Crocker and Wolfe 2001), self-compassion involves treating
oneself kindly in times of failure. In fact, Neff and Vonk
(2009) found that self-compassion is associated with lower
levels of social comparison than global self-esteem and is less
contingent on perceived appearance.
Self-compassion appears to buffer against eating pathology
as well as body dissatisfaction. It has been linked to less severe
binge eating (Webb and Forman 2013), as well as lower levels
of disordered eating in women with clinical eating disorders
(Ferreira et al. 2013). Another study found that self-
compassion fully mediated the link between body dissatisfac-
tion and restrained and disordered eating (Finely-Straus 2011).
There has also been a little research examining how raising self-
compassion can impact disordered eating behaviors. For in-
stance, a study by Adams and Leary (2007) found that inducing
a self-compassionate response to breaking one’s diet attenuated
the tendency for chronic dieters to overeat as a way to reduce
bad feelings associated with the lapse. Another study by Gale
et al. (2012) found that compassion-focused therapy—a general
therapeutic approach designed to help patients develop a sense
of compassion, warmth, and emotional responsiveness toward
themselves (Gilbert, 2010)—significantly improved eating dis-
order symptomatology.
Mindfulness

To our knowledge, there has been no research examining
the impact of self-compassion training on body dissatisfac-
tion, especially among women who are not in therapy for
more serious eating pathologies. There is some research ex-
amining mindfulness training and body dissatisfaction, how-
ever, which is relevant given that mindfulness is a core com-
ponent of self-compassion. For example, Adams et al. (2013)
found that participants who tried on a bathing suit while
listening to a mindfulness training tape had less negative affect
and body image dissatisfaction. Another study found that
combining mindfulness training with mirror-exposure signif-
icantly improved weight/shape concerns and body satisfaction
(Delinsky and Wilson 2006). Two mindfulness-based inter-
ventions—acceptance and commitment therapy and dialecti-
cal behavioral therapy—have also been shown to reduce body
dissatisfaction (Pearson et al. 2012; Telch et al. 2001). In
addition, a study evaluating mindfulness skills and interper-
sonal behavior found a positive relationship between body
satisfaction and mindfulness (Dekeyser et al. 2008). Explicit
training in self-compassion is also likely to attenuate body
dissatisfaction because in addition to bringing mindful aware-
ness to one’s body-related thoughts and emotions, it fosters a
sense of care and tenderness toward the self while experienc-
ing these thoughts and emotions. Thus, self-compassion may
be an especially powerful mechanism for coping with body
image concerns.
Germer and Neff have developed a program designed to
teach self-compassion skills to the general populace called
Mindful Self-Compassion (MSC; Neff and Germer 2013). In
this program, participants meet for 2.5 hr once a week for
8 weeks and also attend a half-day silent meditation retreat.
Formal meditation practices are taught that are designed to
foster a state of self-compassion, and informal practices are
also given such as placing one’s hands on one’s heart in times
of stress. Home practices are assigned at the end of each
session such as writing a compassionate letter to oneself.
Participants are asked to do 40 min of self-compassion prac-
tice each day, which can be a combination of formal and
informal practices. To facilitate formal meditation practice,
self-compassion meditation audio files (approximately
20 min in length) are available for participants to practice at
home. Neff and Germer (2013) recently conducted a random-
ized controlled study of the MSC program. Compared to a
wait-list control group,MSC participants demonstrated a large
(43 %) and significant increase in their self-compassion levels.
Participants also significantly increased in mindfulness, com-
passion for others, and life satisfaction while decreasing in
depression, anxiety, stress, and emotional avoidance. All gains
in study outcomes were maintained at 6-month and 1-year
follow-up points.
The 8-week MSC program appears to be effective at teach-
ing self-compassion and improving well-being and might also
be effective at addressing body image concerns. However, the
full MSC program requires a considerable time commitment
from participants, including physical attendance at weekly
MSC meetings. For this reason, we decided to conduct a study
of a shorter intervention that only required participants to listen
to recordings of the guided self-compassion meditations from
the MSC program for 3 weeks, in order to determine if this
would increase self-compassion and lessen body dissatisfaction
in adult women. This way of delivering the intervention in-
creased convenience, flexibility, and privacy for participants.
There is some indirect evidence that self-compassion can
be increased through home study. In their trial of the Mindful
Self-Compassion (MSC) Program, Neff and Germer (2013)
found a significant increase in self-compassion and mindful-
ness among the waitlist control group as well as the interven-
tion group (although gains for the intervention group were
much larger). In an attempt to explain these findings, they
contacted participants in the waitlist control group and dis-
covered that 50 % reported reading books on self-compassion
(e.g., Germer 2009; Neff 2011) or listening to the meditation
podcasts available online at Neff and Germer’s respective
websites. While the significant increase in self-compassion
displayed by the waitlist group cannot be definitively attrib-
uted to participants’use of the meditation podcasts, results are
suggestive that this type of training may have some effect.
For these reasons, the current study investigated whether
listening to self-compassion meditation audio recordings
could increase self-compassion and improve body image con-
cerns among adult women. This was not an online interven-
tion, which would have involved having participants interact
synchronously with teachers through a web conferencing site.
Rather, we simply offered women access to audio podcasts,
which they could download and listen to on their own. Spe-
cifically, we examined the impact of 3 weeks of self-
compassion meditation training on five variables: self-
compassion, body dissatisfaction, body shame, body appreci-
ation, and contingent self-worth based on appearance. We
decided to recruit participants on the Internet since we wanted
to study a large sample of women of all ages, and the Internet
was a convenient way to recruit this demographic. All survey
questionnaires were also completed online in order to facilitate
data collection.
The study implemented a 2 (experimental vs. waitlist con-
trol group)×2 (baseline, posttreatment) randomized study de-
sign, yielding a between-groups comparison condition. We
hypothesized that controlling for age and prior meditation
experience, women who partook in the self-compassion med-
itation training would experience higher levels of self-
compassion and body appreciation, as well as lower levels
of body dissatisfaction, body shame, and contingent self-
worth based on appearance compared to a waitlist control
group. Although comparison to a waitlist control group was
not as robust as comparison to an active control group, we decide
to use a waitlist since this was a preliminary study primarily
Mindfulness

aimed at determining whether listening to audio podcasts of self-
compassion meditations is effective in the first place.
We also examined whether changes in self-compassion (as
calculated by pre–postdifference scores) experienced by the
intervention group would predict improvements in body dis-
satisfaction, to explore self-compassion as a mechanism of
program effectiveness. We expected there to be a practice
effect, so that the total number of times per week participants
practiced self-compassion meditation would predict pre–
postchanges in other study outcomes. Finally, we expected
that all gains associated with the intervention would be main-
tained at 3-month follow-up.
Method
Participants
Participants were recruited through an advertisement inviting
women with body image concerns to participate in a study
involving meditation. The advertisement was posted on a
variety of Internet sites, particularly sites containing informa-
tion about body image, disordered eating, and eating disor-
ders. We targeted women with body image concerns so we
could conduct the study with women who were experiencing
some level of body dissatisfaction-related distress. Advertise-
ments were also placed on Facebook, LinkedIn, Twitter, Ya-
hoo groups, and various other websites related to body image
such as wearetherealdeal.com and weightless (blogs.
psychcentral.com/weightless/). Several individuals with
listservs or group e-mail newsletters dealing with body dissat-
isfaction and/or eating disorders also e-mailed their list infor-
mation about the study, and LinkedIn and Yahoo groups for
therapists were used to refer suitable participants to the study.
Snowball sampling was also utilized. The most common
places that women reported finding out about the study were
websites (35 %) followed by referrals from friends and ther-
apists (23 %), and Facebook (20 %).
The only requirements to participate were being female,
over 18, and having Internet access. The chance to win a gift
card (four $25 and one $100) was offered as an incentive for
starting and completing the study. Initially, 479 adult women
expressed interest in participating in the study, and after elec-
tronically signing a consent form, they were randomized to
either the intervention group or the waitlist control group. Of
this total, 32 women did not complete the initial pre-test
survey (12 from the intervention group and 20 from the
control group) and 242 (133 from the intervention group and
109 from the control group) did not complete the posttest
survey, either due to technical difficulties, because they indi-
cated they did not have time, or for unknown reasons. In
addition, nine participants in the intervention group who com-
pleted the posttest survey were eliminated from the study
because they indicated they did not listen to the mediation
podcasts at all. The final pool of participants therefore includ-
ed 228 adult women: 130 in the control group and 98 in the
intervention group.
Participants ranged in age from 18 to 60. Of the interven-
tion participants (Mage= 36.42, SD = 1.31) 43 % reported
having no prior meditation experience, 45 % had meditated
occasionally, and 12 % were regular meditators. Of the
control-group participants (Mage=38.42, SD= 1.42) 44 %
reported never having meditated, 45 % had mediated occa-
sionally, and 11 % were regular meditators. ttests indicated
that there were no significant differences between the two
groups on age and prior meditation experience as well as the
five dependent study variables: self-compassion, body dissat-
isfaction, body shame, body appreciation, and contingent self-
worth based on appearance, (ps>.05). The majority of partic-
ipants (95 %) were white and reported either living in the USA
(80 %), Canada (10.4 %), Australia (4.4 %), the UK (4 %), or
another country (1.2 %).
Measures
Baseline and postintervention measures were completed on-
line 1 or 2 days prior to and after the end of the 3-week
program. Participants in the intervention group were also
given all the study measures again 3 months after completion
of the program to determine if any improvements that were
found would be maintained over time. About half (N=51) of
these participants completed the 3-month follow-up assess-
ment. Participants in the intervention group were also provid-
ed with an opportunity at the end of the second survey to
comment on their experience. Those in the waitlist-control
group received the audio podcasts 3 weeks after the interven-
tion group completed their trial, but were not surveyed again.
Self-Compassion The Self-compassion Scale (SCS; Neff
2003a) is a self-reported, 26-item measure with responses
ranging from 1 (almost never) to 5 (almost always). It contains
six subscales (negative subscales are reverse-coded): self-
kindness (e.g., I try to be loving towards myself when I am
feeling emotional pain), self-judgment (e.g., I am
disapproving and judgmental about my own flaws and inad-
equacies), common humanity (e.g., When things are going
badly for me, I see the difficulties as part of life that everyone
goes through), isolation (e.g., When I think about my inade-
quacies, it tends to make me feel more separate and cut off
from the rest of the world, mindfulness (e.g., When I am
feeling down I try to approach my feelings with curiosity
and openness), and overidentification (e.g., When I am feeling
down I tend to obsess and fixate on everything that is wrong).
The subscales of the SCS may be examined separately, or else
a total self-compassion score can be used given that a single
higher-order factor of “self-compassion”has been found to
Mindfulness

explain the intercorrelations between subscales (Neff 2003a).
Note that the self-judgment, isolation, and overidentification
subscales of the SCS are reverse-coded so that higher scores
indicate higher levels of self-compassion. Internal consistency
reliability for the total scale was α=.95, and ranged from .70
to .84 for the subscales.
Body Dissatisfaction To measure body dissatisfaction we
used the Body Shape Questionnaire (Cooper et al. 1987), a
widely used scale that measures concerns about body shape
and body dissatisfaction. We used the shortened 16-item ver-
sion of the scale approved for use by the scale authors (Evans
and Dolan 1993). Items are worded negatively to gauge body
dissatisfaction (e.g., Has being with thin women made you
feel self-conscious about your shape?) and range from 1
(never) to 6 (always). Items are averaged to obtain a mean.
Higher scores indicate a higher level of body dissatisfaction.
Internal consistency reliability was α=.93.
Body Shame The eight-item Body Shame subscale of the
Objectified Body Consciousness Scale (McKinley and Hyde
1996) measures how an individual feels about herself if she
does not fulfill cultural expectationsfor her body (e.g.,When I
cannot control my weight, I feel like something must be
wrong with me). Items are rated on a scale ranging from 1
(strongly disagree) to 7 (strongly agree), and higher scores
indicate a higher level of body shame. Internal consistency
reliability was α=.86.
Body Appreciation While there are numerous instruments that
measure negative body image, the self-reported, 13-item Body
Appreciation Scale (Avalos et al. 2005) is the first instrument
to conceptualize and assess body image as a positive dimen-
sion (e.g., I feel good about my body; I feel that my body has
at least some good qualities). Items range from 1 (never) to 5
(always). Higher scores indicate a higher level of body appre-
ciation. Internal consistency reliability was α=.94.
Contingent Self-Worth based on Appearance The Contingen-
cies of Self-Worth Scale (CSW; Crocker et al. 2003) is a 35-
item scale that focuses on seven different domains of self-
worth contingency, but only the Appearance subscale was
used in the current study. Items are rated on a scale from 1
(strongly disagree) to 7 (strongly agree). The CSW for Ap-
pearance subscale consists of five questions (e.g., When I
think I look attractive, I feel good about myself). Higher
scores indicate higher levels of self-esteem contingency based
on appearance. Internal consistency reliability was α=.76.
Intervention
The intervention given to participants lasted 3 weeks. Re-
search on mindfulness training suggests these types of short
practice periods can be efficacious (Britton et al. 2010;Glück
and Maercker 2011;Tangetal.2007). Each week, partici-
pants received a link to a different podcast (mp3 audio
file) containing a 20-min self-compassion meditation
with the instructions: “Please try to listen to it once
perdayforthenextweek.”Three different guided
self-compassion meditations that are taught in the Mind-
ful Self-Compassion program (Neff and Germer 2013)
were used for the intervention. (These podcasts are
available at www.selfcompassion.org.)
The first week’s meditation, the Compassionate Body
Scan, is designed to help the listener get in touch with body
sensations and bring a sense of compassion, peace, and grat-
itude to her body. The listener is instructed to lie down
and rest a hand on her heart as a reminder to be kind to
herself. Starting with the feet and working up to the
head, the listener is asked to notice the sensations of
various body parts. If judgmental thoughts arise, the
participant is told to place a hand on her heart, breath
deeply, and return to feeling simple sensations.
The second week’s meditation, Affectionate Breathing,
asks the listener to first get in touch with her body by doing
a quick body scan and noticing any sensations. The listener is
then told to take three deep breaths to let out any tension and
then to allow breathing to return to normal. Next, she is asked
to notice where the breath is felt most strongly without trying
to control the breath. The listener then is told to adopt a
little half smile and observe how she feels. She is then
askedtosetanintentiontobreathinaffectionand
kindness for herself and with each out breath to breathe
out affection and kindness towards others who are suf-
fering just like her. The listener is told not to judge her
mind when it wanders. The listener is instructed to
appreciate each breath and allow the breath to comfort
and soothe, and finally to rest in the feelings of kind-
ness she is generating.
The final week’s meditation is a variant of loving-
kindness meditation (Hofmann et al. 2011) that is fo-
cused on having self-compassion for a personal experi-
ence of suffering. First, the listener is instructed to be
present in the moment, to notice any sounds that are
arising, and then to focus on the breath. She is then
asked to bring attention to a trait or behavior that has
generated negative emotions and allow whatever feel-
ings are connected with this perceived inadequacy to
arise. She is then instructed to locate the physical sen-
sation of these emotions in her body and allow them to
be there. The listener is then told to place both hands
over her heart, and to soothe and comfort herself for the
difficult thoughts and emotions she is experiencing. The
listener is then asked to silently repeat the following
phrases to herself: May I be safe. May I be peaceful.
May I be kind to myself. May I accept myself as I am.
Mindfulness

Results
The mean number of days that participants reported listening
to the podcasts per week was 3.60 (range 1–7; SD= 1.88).
There were no mean differences between groups on any study
variables at pretest (ps<.05). Bivariate correlations for the
entire sample (intervention and waitlist control groups) were
calculated for all the study variables at pretest. As shown in
Tab le 1, self-compassion was significantly correlated with all
body image-related variables, which were all significantly
correlated with each other (ps < .01). Note that age and prior
meditation experience were also significantly linked to many
study variables. For this reason, all analyses controlled for age
and prior meditation experience.
In order to determine if the intervention group showed a
greater degree of improvement than the waitlist control group,
outcomes were examined using a series of 2 (intervention)×2
(time) repeated measures ANCOVAs using age and prior
meditation experience as covariates. Results are shown in
Tab le 2, including effect sizes calculated by examining gain
scores with Cohen’sd.
The intervention group demonstrated significantly greater
gains in self-compassion compared to the control group, with
Cohen’sdindicating a large effect size of group participation
(Cohen 1988). (As indicated in Table 3, gains were significant
on all six SCS subscales). Compared to the control group,
participants in the intervention group also evidenced signifi-
cantly greater reductions in body dissatisfaction (medium
effect size), body shame (medium effect size), and contingent
self-worth based on appearance (small effect size), while
experiencing significantly greater gains in body appreciation
(medium effect size).
Three months after completion of the program, participants
in the intervention group filled out the questionnaire again.
Matched-pairs ttests indicated that, at 3-month follow-up,
levels of self-compassion (M=3.25, SD=0.88), body dissatis-
faction (M=3.01, SD=0.99), body shame (M= 3.52, SD =
1.46), body appreciation (M=3.35, SD= 0.95), and contingent
self-worth for appearance (M=4.60, SD=1.14), were signifi-
cantly different than pretest (ps <.05), but were not significant-
ly different from posttest (ps>.05), indicating that gains in all
outcomes were maintained after the intervention.
Next, controlling for age and prior meditation experience,
we examined whether increased self-compassion predicted
improved body image concerns among the intervention group
using pre–postresidual change scores (see Table 4). A series of
regression analyses were conducted that assessed the relation-
ship of pre–postchange in self-compassion to pre–postchange
in the body image variables. It was found that increased self-
compassion was significantly associated with improvements
in all variables: body dissatisfaction, body shame, body ap-
preciation, and contingent self-worth based on appearance.
Finally, an analysis was conducted to examine whether
amount of practice (i.e., how often participants listened to
the self-compassion meditation podcasts) was associated with
pre/post changes in the dependent variables within the inter-
vention group. Results (see Table 5) indicated that only body
appreciation was significantly related to the number of days a
week that participants meditated, with greater meditation time
predicting greater gains in appreciation.
Discussion
The results from this study suggest that listening to guided
self-compassion meditation podcasts for 3 weeks has a posi-
tive impact on self-compassion and body image in women. It
should be noted that many participants reported having posi-
tive experiences of the intervention. Comments included:
“The podcasts were great,”“They were very relaxing,”“I
surprised myself by how much I enjoyed listening to the
meditations. I was also pleasantly surprised how aware and
connected it made me feel to my body, mind and spirit,”and
“This was a wonderful experience, which I strongly recom-
mend to all women.”
Study results suggested that the intervention was effective
at increasing self-compassion. Those who were randomly
assigned to listen to the meditation podcasts evidenced signif-
icantly greater increases in self-compassion (19 %) than those
randomly assigned to a waitlist control group (5 %), with a
large effect size indicated. In addition, the intervention led to
significant improvements on all six aspects of self-
compassion (self-kindness, self-judgment, common humani-
ty, isolation, mindfulness, and over-identification), suggesting
that the meditations fostered self-compassion in a holistic
manner. Neff and Germer (2013) found that attending a full
8-week Mindful Self-Compassion program was found to raise
self-compassion by 43 %. The fact that significant gains in self-
compassion scores were still obtained in a much shorter, more
accessible format suggests that there may be a variety of effec-
tive ways to increase self-compassion. Given the burgeoning
Ta b l e 1 Bivariate associations between study variables
Measure Age PME SC BD BS BA
PME .23** –––––
SC .41** .24** ––––
BD −.26** −.20** −.62** –––
BS −.18* −.16* −.67** .81** ––
BA .24** .24** .72** −.76** −.80** –
CSWA −.09 −.08 −.48** .58** .55** −.51**
PME prior meditation experience, SC self-compassion, BD body dissat-
isfaction, BS body shame, BA body appreciation, CSWA contingent self-
worth–appearance
*p<.05; **p<.01
Mindfulness

literature documenting the mental health benefits of self-
compassion (Barnard and Curry 2011), finding a relatively
quick and easy way to increase self-compassion is important.
The main purpose of this study was to determine if self-
compassion meditation training would improve body image
concerns in women. Results indicated that the self-
compassion intervention significantly decreased body dissat-
isfaction compared to controls, with a medium effect size
observed. There are several means by which practicing self-
compassion may have mitigated body dissatisfaction. First,
the intervention may have decreased participants’tendency to
criticize their bodies by teaching them to treat themselves
kindly rather then judgmentally. By lessening the constant
stream of negative self-talk and relating to oneself with greater
tenderness and care, participants appeared to develop a more
accepting stance towards their bodies. The sense of common
humanity inherent in self-compassion may have also lessened
body dissatisfaction by helping participants see the bigger
picture—remembering that bodies come in all shapes and
sizes and those comparisons with narrow standards of ideal
beauty are too limited. An increase in mindfulness, moreover,
the third element of self-compassion, may have decreased
body dissatisfaction by enabling participants to see their
bodies more clearly and with greater balance, without exag-
gerating perceived flaws.
Body shame also lessened after participants completed the
intervention, with a medium effect size indicated. According
to objectification theory (Fredrickson and Roberts 1997),
women’s bodies are socially constructed as objects to be
watched and evaluated. As women learn to habitually monitor
themselves, they also come to feel self-conscious and
ashamed if their bodies do not meet ideal standards of beauty.
It appears that helping women to take a more compassionate
stance toward themselves lessened this sense of shame, con-
sistent with other research findings that self-compassion at-
tenuates shame and other self-conscious emotions (Ferreira
et al. 2013; Gilbert and Procter 2006;NeffandVonk2009).
In addition, the intervention was found to increase body
appreciation, with a medium effect size observed. These find-
ings are in line with previous research that indicates that self-
compassion is linked to an increase in psychological strengths
such as gratitude, happiness, and life satisfaction (Breen et al.
2010; Heffernan et al. 2010; Hollis-Walker and Colosimo
2011; Neff and Germer 2013;Neffetal.2007). By embracing
oneself with kindness, connectedness, and equanimity, self-
compassion meditation appears to generate a positive attitude
Ta b l e 2 Pre- and posttest mean scores by group and MSC intervention effects analyzed with 2 (group)×2 (time), repeated measures ANACOVAs
(controlling for age and prior meditation experience), and Cohen’sdeffect sizes calculated with gain scores
Outcome Intervention group Wait-list controls Fd
Pretest Posttest Pretest Posttest
M(SD) M(SD) M(SD) M(SD)
Self-compassion 2.65 (0.78) 3.15 (0.75) 2.62 (0.68) 2.74 (0.72) 37.37** 0.82
Body dissatisfaction 3.40 (1.11) 2.96 (1.06) 3.45 (0.96) 3.41 (1.02) 28.22** 0.73
Body shame 4.25 (1.50) 3.56 (1.47) 4.32 (1.38) 4.20 (1.30) 24.11** 0.68
Body appreciation 2.98 (0.92) 3.39 (0.86) 2.96 (0.85) 3.07 (0.85) 20.87** 0.62
CSW–appearance 5.30 (1.01) 4.91 (1.04) 5.51 (0.87) 5.31 (0.87) 10.99* 0.45
*p<.01; **p<.001
Ta b l e 3 Pre- and posttest mean scores for self-compassion subscalesby group and MSC intervention effects analyzed with 2 (group)× 2 (time), repeated
measures ANACOVAs (controlling for age and prior meditation experience), and Cohen’sdeffect sizes calculated with gain scores
Outcome Intervention group Wait-list controls Fd
Pretest Posttest Pretest Posttest
M(SD) M(SD) M(SD) M(SD)
Self-kindness 2.77 (0.91) 3.19 (0.88) 2.60 (0.84) 2.79 (0.85) 18.22* 0.58
Self-judgment 2.40 (0.89) 3.03 (0.93) 2.38 (0.82) 2.48 (0.81) 34.51* 0.80
Common humanity 2.82 (0.98) 3.24 (0.86) 2.88 (0.88) 2.91 (0.97) 11.04* 0.46
Isolation 2.46 (1.00) 2.98 (0.96) 2.45 (0.90) 2.58 (0.91) 15.16* 0.53
Mindfulness 3.07 (0.88) 3.59 (0.76) 3.00 (0.74) 3.14 (0.80) 12.91* 0.49
Overidentification 2.45(0.89) 3.01 (0.91) 2.49 (0.84) 2.56 (0.87) 19.32* 0.60
The subscales of self-judgment, isolation, and overidentification are reverse coded so that higher scores represent lower levels of these constructs
*p<.001
Mindfulness

towards one’s body, helping women to stop taking their bodies
for granted and start being grateful for their bodies as they are.
The intervention appeared not only to change women’s
attitudes toward their bodies but also the foundations upon
which their attitudes rest. Compared to controls, participation
in the intervention was found to significantly decrease the
degree to which self-worth was contingent on perceived ap-
pearance, with a small effect size indicated. Since appearance
tends to be the most important domain of self-worth for
women (Harter 1999), the fact that contingent self-worth on
appearance was reduced suggests that self-compassion may
help women discover a new way of relating to themselves.
Moreover, because most women cannot obtain the ideal beau-
ty standards required to feel successful in the domain of
appearance, reducing self-worth contingency in this area is
likely to improve both self-concept and psychological well-
being (Overstreet and Quinn 2012; Breines et al. 2008). In
contrast to self-esteem, which requires women to positively
evaluate their looks in order to feel good about themselves,
self-compassion offers more stable and unconditional feelings
of self-worth (Neff and Vonk 2009).
Finally, this study examined whether the frequency of
meditation during the intervention would influence changes
in self-compassion and body image outcomes. Somewhat
surprisingly, frequency of listening to the self-compassion
podcasts was significantly associated with body appreciation
only, and no other outcome variables were predicted by med-
itation frequency. It may be that a more robust effect was not
observed because all participants meditated on average be-
tween three and four times per week, possibly creating a
ceiling effect. Another explanation is that even brief exposure
to self-compassion is enough to significantly change behavior.
Forexample,researchbyAdamsandLeary(2007)demon-
strated that just briefly inducing the idea of self-compassion
reduced the amount of distress that dieters felt after eating
caloric foods. While it is unclear why body appreciation was
linked to meditation frequency but other variables were not, it
might be that the development of body appreciation is partic-
ularly dependent on exposure to meditations that increase
body awareness in a kind and comforting manner.
Limitations and Future Research
As in any research design, there were several limitations to the
current study. First, confidence in study results is limited
because a waitlist rather than active control group was used.
While the meditation treatment appeared to be effective, a
placebo effect may have been operating given that the control
and intervention groups were aware of the differences in
treatment. The intervention group clearly knew that they were
doing something positive for themselves, while the waitlist
control group was told they would receive the treatment (i.e.,
meditations) in 3 weeks after completing the second survey. In
fact, the return rate for the posttest survey was 18 % higher for
waitlist controls compared to the intervention participants,
perhaps because they had the extra incentive of receiving the
meditation podcasts after completing the second survey. De-
spite these limitations, this study does suggest that self-
compassion training is potentially beneficial and that it is
worthy of further study in comparison to other interventions.
For instance, it would be useful to compare the effects of self-
compassion meditation training with a conventional body scan
meditation or cognitive behavioral therapy, the current standard
treatment for body dissatisfaction (Jarry and Berardi 2004).
Another issue is that reports of how often participants
meditated were reliant on self-report. To help insure that
subjects listened to the meditations in future research, it would
be beneficial to include a manipulation check where respon-
dents briefly summarize what was on the podcasts, or else
listen to the meditations while online using a program that
tracks amount of time the podcasts were played. There was
also a significant attrition rate in this study, with roughly half
of participants dropping out of the study or not completing
follow-up measures. According to Eysenbach (2005), attrition
rates for studies conducted over the Internet tend to be much
higher than for studies conducted through more traditional
means, particularly with self-help applications. For example,
a study evaluating a depression program called Moodgym had
a completion rate of only 0.5 % (Christensen et al. 2004). In
the world of Internet based research, therefore, the attrition
rate observed in this study is actually low. Still, it may be that
Ta b l e 4 Standardized regression coefficients for pre-/postresidual
changes in self-compassion (SC) predicting pre/post residual changes in
study outcomes in the intervention group controlling for prior meditation
experience and age
Outcome BR
2
BSE(B)
Body dissatisfaction −.53* 0.39 −0.40 0.07
Body shame −.32* 0.45 −0.59 0.04
Body appreciation .59* 0.43 0.55 0.08
CSW-appearance −.36* 0.22 −0.24 0.06
*p<.001
Ta b l e 5 Standardized regression coefficients for meditation frequency
predicting pre-/postresidual changes in study outcomes, controlling for
prior meditation experience and age
Outcome BR
2
BSE(B)
Self-compassion .14 .11 .04 .03
Body dissatisfaction −.06 .05 −.03 .04
Body shame −.01 .02 −.00 .03
Body appreciation .28* .14 .09 .03
CSW–appearance −.01 .04 −.05 .05
*p<.01
Mindfulness

it was mainly people who benefitted from the intervention
who remained in the study, and future research should inves-
tigate this possibility.
It should be noted that the participants who were attracted
to this study were very specific: women who wanted to feel
better about their bodies. Women were recruited largely from
websites that discussed eating disorders and body image;
therefore, it cannot be concluded that this intervention would
positively affect women who were not concerned with their
body image. However, given that body dissatisfaction is so
prevalent, women who responded to the invitation to feel
better about their bodies may have been more representative
of the general population than one might imagine. The lack of
ethnic diversity in the sample should also be noted, with the
large majority of participants being white women from
English-speaking Western countries. However, the demo-
graphic survey questions did not include a category for His-
panic, so there may have been more ethnic diversity then what
was observed. Even so, the results of this study cannot neces-
sarily be generalized to other cultural, ethnic, or racial groups.
Because this is the first study (to our knowledge) to explore
the effects of self-compassion training on body image con-
cerns in women, more studies are needed to replicate and
extend these findings. For instance, levels of self-
compassion, body dissatisfaction, body shame and body ap-
preciation all varied as a function of age, and it may be that the
effectiveness of interventions such as this one also differ
according to age. Future research should examine this issue
in order to determine if specific features of self-compassion
training or its outcomes vary according to stage of life. Sim-
ilarly, future studies might usefully examine whether body
mass index influences the link between self-compassion and
body image concerns, as it is highly correlated with body
dissatisfaction (McLaren and Kuh 2004). Determining the
characteristics of individuals who best learn self-compassion
using recorded material verses learning self-compassion in a
group setting with a trained professional may also be impor-
tant. Finally, since body dissatisfaction has been shown to be a
central factor in the development of eating disorders
(American Psychiatric Association 2000), it would be worth
investigating whether self-compassion meditation also re-
duces disordered eating behaviors.
Finally, while this study examined the impact of 3 weeks of
self-compassion meditation training on body image concerns,
other forms of brief self-compassion training may also be
efficacious. For example, Shapira and Mongrain (2010)ex-
amined the impact of writing a self-compassionate letter to
oneself for 5 days and found that it predicted decreased
depressionfor 3 months and increased happiness for 6 months.
One could easily imagine tailoring such an intervention to
focus on self-compassionate letter writing with regard to body
image issues. Similarly, some of the compassionate imagery
techniques employed in compassion-focused therapy (Gilbert
2010) might be effective at increasing self-compassion and
improving body image in a relatively brief time period.
In conclusion, this study suggests that self-compassion
training may be an effective way to help women feel better
about their bodies in a world that constantly tells them they are
not thin enough. The fact that the intervention was completely
conducted over the Internet is also encouraging. Given that an
estimated 76.8 % of people living in the developed world and
30.7 % of people living in the developing world use the
Internet (International Telecommunications Union 2013), the
possibility of helping women to feel better about their bodies
using a free and easily accessible technology holds great
promise for enhancing women’swell-being.
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