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Effects of Self-Compassion Workbook Training on Trauma-Related Guilt in a Sample of Homeless Veterans: A Pilot Study
Abstract
Objective
The present pilot study examined the effects of a 4-week-long self-administered self-compassion training on trauma-related guilt and compared it to a stress inoculation control group.MethodA total of 47 homeless male veterans who were living in transitional housing facilities volunteered to participate in this study. Participants were randomly assigned to either a self-compassion (N = 13) or a stress inoculation (N = 14) group and were asked to complete pre-, mid-, and postintervention assessments measuring changes in self-compassion, trauma-related guilt, and posttraumatic stress disorder severity.ResultsParticipants in both interventions reported increased levels of self-compassion and equal reductions in trauma-related guilt. No other significant changes were noted.Conclusions
The results from this pilot study provide preliminary evidence for the use of self-compassion and stress inoculation trainings as effective interventions for trauma-related guilt. The findings also suggest that self-administered trainings in the form of workbooks may be a viable, cost-effective form of intervention for disadvantaged populations, such as homeless veterans in transitional housing, who may lack resources or access to professionals or paraprofessionals. The effects of both self-compassion training and stress inoculation training on the study variables and directions for future research on self-compassion and trauma-related guilt are discussed.
... For example, in a sample of veterans, 72% attended at least three-quarters of a 12-week facilitator-led Loving-Kindness meditation (Kearney et al., 2013). The only pre-existing study of self-compassion in homeless persons revealed that 57% of participants re-engaged following a 4-week self-led workbookbased intervention (Held & Owens, 2015). While the lower retention rate here is attributable to a broad range of factors, both the selfled nature of the intervention and the transiency of homelessness are likely contributors. ...
... Accordingly, enhanced DSO interventions may be required in this group, given the prevalence of childhood trauma and accompanying feelings of shame and harsh self-criticism (Fall, 2015;Sundin & Baguley, 2015). These feelings (alongside guilt) make contact with traumatic memories in therapy painful to the point that detachment and numbing may occur, which is linked with poor therapeutic outcomes (Braehler & Neff, 2020;Brewin, 2019;Held & Owens, 2015). Self-compassion based interventions have been shown to effectively target these feelings (Gilbert & Procter, 2006;Held & Owens, 2015). ...
... These feelings (alongside guilt) make contact with traumatic memories in therapy painful to the point that detachment and numbing may occur, which is linked with poor therapeutic outcomes (Braehler & Neff, 2020;Brewin, 2019;Held & Owens, 2015). Self-compassion based interventions have been shown to effectively target these feelings (Gilbert & Procter, 2006;Held & Owens, 2015). In a recent review on self-compassion and PTSD, Braehler and Neff (2020) highlighted that self-compassion based interventions may add specific value in helping patients move from avoidance and/or overidentification with feelings to awareness of emotions and the present-moment, from isolation to shared connection with others, and from harsh self-criticism to caring for oneself. ...
Background
In 2018, Complex Post-Traumatic Stress Disorder (CPTSD) was accepted into the International Classification of Diseases, edition 11 (ICD-11) to capture symptoms associated with exposure to chronic, inescapable trauma. Thereafter, the disorder's links with interpersonal trauma have been established.
Objective
Within a sample of homeless adults in Ireland, the (1) prevalence of ICD-11 disorders specifically associated with stress; Post Traumatic Stress Disorder (PTSD) and CPTSD, (2) nature of interpersonal trauma exposure, self-identified index events, and their association with the diagnostic criteria of CPTSD, and (3) relationship between cumulative interpersonal trauma exposure and CPTSD via self-compassion were examined.
Participants and setting
Adults using homeless services (N = 56) completed self-report measures of socio-demographics, trauma-history, PSTD, CPTSD, and self-compassion.
Methods
The data were analysed using chi-squared and mediation analyses (via PROCESS).
Results
CPTSD was highly prevalent (33.9%) among the sample, but PTSD was not (3.6%). Emotional neglect was the most prevalent interpersonal trauma and the most common index event. Only lifetime sexual abuse (from someone other than a parent or guardian) was associated with CPTSD diagnostic status (χ² = 3.94, (1), p = .047). When adjusted for gender, relationship status, and living situation, self-compassion mediated the relationship between cumulative interpersonal trauma exposure and CPTSD severity (B = 1.30, SE = 0.50, 95% CI = [0.43–2.35]).
Conclusion
Findings support the relevance of CPTSD to understanding psychopathology in homeless adults and the potential role of self-compassion in interventions. Further, they open debate on the nature of events that are considered traumatic – subjectively and in psychiatric canon.
... A recent study supported the efficacy of self-compassion interventions across diverse populations (Ferrari et al., 2019). Moreover, the literature varied in the number of sessions from four to twelve (Au et al., 2017;Evans et al., 2019;Grodin et al., 2019;Held & Owens, 2015). Studies have demonstrated that the efficacy of self-compassion-focused therapies is shaped by the number of training session (Phillips & Hine, 2019;Wakelin et al., 2021). ...
... Only four studies included a control group (Held & Owens, 2015;Lang et al., 2019;Lee et al., 2017;Valenstein-Mah et al., 2019). Among these four studies, self-compassion-focused interventions showed no effect on PTSD (SMD = − 0.61, 95%CI: [− 1.24, 0.02], p = 0.06). ...
... Among these four studies, self-compassion-focused interventions showed no effect on PTSD (SMD = − 0.61, 95%CI: [− 1.24, 0.02], p = 0.06). However, one study conducted an intervention in the absence of a therapist (Held & Owens, 2015). Meta-regression indicated that session number had an effect on intervention outcomes (p < 0.001), suggesting that longer interventions were associated with better PTSD outcomes. ...
Objectives
Self-compassion-focused interventions may be able to decrease posttraumatic stress symptoms. However, previous studies demonstrated mixed effects in which a series of confounders were not systematically quantified. In this study, a systematic review with meta-analysis was conducted to quantify the effects of self-compassion-focused therapies on posttraumatic stress disorder.
Methods
Twelve eligible studies were included after a systematic search of databases. Outcome measures were extracted for posttraumatic stress disorder.
Results
Our data indicated a medium protective effect on posttraumatic stress symptoms (SMD = − 0.65), with most of the studies (8/12) coming from clinical settings. More importantly, longer interventions were associated with better posttraumatic stress outcomes (p < 0.001). Baseline or changes in self-compassion scores were not associated with posttraumatic stress outcomes post-interventions.
Conclusions
Overall, findings from this meta-analysis quantified the complex influence of self-compassion-focused interventions on posttraumatic stress symptoms and may provide insights for optimizing intervention strategies.
Systematic Review and Meta-analysis Registration: PROSPERO CRD42020208663
... There was heterogeneity between the studies' designs and methods. Ten (59%) were cross-sectional/correlational exploratory studies Dahm et al., 2015;Eicher et al., 2013;Forkus et al., 2019aForkus et al., , 2019bHiraoka et al., 2015;Kelley et al., 2019;Meyer et al., 2018Meyer et al., , 2019Rabon et al., 2019), five (29%) included a longitudinal component (Hiraoka et al., 2015;Kearney et al., 2013Kearney et al., , 2014Meyer et al., 2018Meyer et al., , 2019, four (24%) were pilot studies (Collinge et al., 2012;Held & Owens, 2015;Kerney et al., 2013Kerney et al., , 2014, one (6%) was either a RCT (Collinge et al., 2012), a Quasi-Experiment (Berger-Cico et al., 2018), or a case study (Klich, 2016). Additionally, two (12%) studies included qualitative data, either online responses to an open-ended question or focus groups (respectively: Berger-Cico et al., 2018;Collinge et al., 2012). ...
... Five studies (29%) were online studies Forkus et al., 2019aForkus et al., , 2019bKelley et al., 2019;Rabon et al., 2019) and four (24%) had an online component (Berger-Cico et al., 2019;Collinge et al., 2012;Held & Owens, 2015;Kahn et al., 2016). Recruitment was mostly via advertisements either online or on study sites. ...
... Recruitment was mostly via advertisements either online or on study sites. Ten studies (59%) were delivered in the study sites, mostly clinical settings (Berger-Cico et al., 2019;Dahm et al., 2015;Eicher et al., 2013;Hiraoka et al., 2015;Kerney et al., 2013Kerney et al., , 2014Klich, 2016;Meyer et al., 2018;, with the exception of the Held and Owens (2015) study that was delivered in a Veteran Affairs (VA) transitional housing facility. Overall, eight studies (47%) reported training/educational programs or courses delivered to participants within their home (Collinge et al., 2012;Held & Owens 2015;Kahn et al., 2016) or at facilities (Berger-Cico et al., 2019;Kerney et al. 2013Kerney et al. , 2014, with Klich (2016) one case study conducted in a clinical treatment session. ...
There is evidence to suggest that self-compassion is related to positive health and wellbeing outcomes, therefore, this paper explores this concept within the military veteran population. The aim of this review was to identify research and explore the evidence based
of self-compassion as a protective factor, from negative health outcomes, amongst military veterans.
... Krabbenborg Regarding outcome variables in the included studies, seven studies assessed substance use behaviours such as substance craving, addiction severity, drug dependency, and drinking status (Chang et al., 2010;Garland et al., 2016;Malte et al., 2017;Reback et al., 2010;Salem et al., 2017;Toro et al., 1997;Upshur et al., 2015). Depression was assessed in five studies (Garland et al., 2016;Guo et al., 2016;Himle et al., 2014;Krabbenborg et al., 2017;Medalia et al., 2017), anxiety in five studies (Chang et al., 2010;Garland et al., 2016;Himle et al., 2014;Krabbenborg et al., 2017;Medalia et al., 2017), mental health status in four studies (Chang et al., 2010;Guo et al., 2016;Malte et al., 2017;Upshur et al., 2015), PTSD symptoms in three studies (Garland et al., 2016;Held & Owens, 2015;Lester et al., 2007), psychological distress in two studies (Medalia et al., 2017;Toro et al., 1997), self-efficacy in two studies (Guo et al., 2016;Toro et al., 1997), and quality of life in two studies (Krabbenborg et al., 2017;Shern et al., 2000). ...
... respectively). Although three studies (Garland et al., 2016;Held & Owens, 2015;Lester et al., 2007) evaluated PTSD symptoms, we pooled data from two studies (Garland et al., 2016;Held & Owens, 2015), which reported sufficient numerical data for a meta-analysis. ...
... respectively). Although three studies (Garland et al., 2016;Held & Owens, 2015;Lester et al., 2007) evaluated PTSD symptoms, we pooled data from two studies (Garland et al., 2016;Held & Owens, 2015), which reported sufficient numerical data for a meta-analysis. ...
Aims:
To evaluate the effect of psychosocial interventions for homeless adults on their psychosocial outcomes DESIGN: A systematic review and meta-analyses were performed for critical appraisal and synthesis of the included studies.
Data sources:
A systematic search of studies published before September 10, 2018 was performed using PubMed, Cochrane Library, EMBASE, PsycINFO and CINAHL.
Review methods:
The review included randomized controlled trials conducting psychosocial interventions and assessing psychosocial outcomes for homeless adults. After systematically describing study and intervention characteristics, we conducted meta-analyses by the type of outcome and subgroup meta-analyses by the type of intervention and outcome. Fourteen studies were included in this review and 11 were included in the meta-analyses.
Results:
A significant effect of psychosocial interventions in reducing anxiety and enhancing mental health status among homeless adults was noted.
Conclusion:
The meta-analyses showed that psychosocial interventions may reduce anxiety and enhance the mental health status of homeless people. Specifically, we suggest that relaxation response training may be effective in improving anxiety and mental health status and cognitive behavioral therapy may reduce anxiety.
Impact:
Although psychosocial interventions for homeless persons have been implemented for a decade, their impact for psychosocial outcomes among homeless adults has not been evaluated. This review suggest that psychosocial interventions may improve anxiety and mental health status among homeless adults. The findings of the present study may provide directions for developing psychosocial interventions to help vulnerable homeless adults in managing psychological outcomes.
... Self-compassion inductions have also become more prevalent in addressing issues related to trauma. Most early literature examining the effects of self-compassion inductions for those who experience trauma focus largely on veterans or general traumatic experiences (Held & Owens, 2015;Hoffart et al., 2015;Kearney et al., 2015;Klich, 2016). In fact, very little research to date examines self-compassion (correlationally or in the context of interventions) specifically in women who have experienced sexual assault. ...
... Although past research has shown that self-compassion focused practices are beneficial when used in the treatment trauma in general (Held & Owens, 2015;Hoffart et al., 2015;Klich, 2016), it is thought that women survivors of sexual abuse may experience unique challenges compared to other groups experiencing other types of trauma when engaging in selfcompassion exercises (Boykin et al., 2018;Tesh, Learman, & Pulliam, 2013). Tesh et al. (2013) provide a theoretical background for appropriateness of self-compassion inductions in the treatment of those who experience intimate partner violence (IPV; i.e. intimidation as well as physical and sexual assault and battery). ...
... Past research examining trait self-compassion (e.g. Thompson & Waltz, 2008) as well as induced self-compassion (Held & Owens, 2015;Hoffart et al., 2015;Kearney et al., 2015;Klich, 2016)has shown that self-compassion has promising implications in the treatment of those who have experienced potentially traumatic events. Self-compassion may be an important component in recovering from or buffering against negative outcomes related to traumatic experiences. ...
In the current exploratory study, differences in self-compassion were examined for women who listed experiencing sexual assault related trauma and nonsexual assault trauma (e.g. violent death or injury of loved one, witnessing death, injury to self, natural disasters, acts of war). Results indicate that individuals who have experienced sexual assault report significantly lower levels of self-compassion compared to those who experience traumas that do not involve sexual assault. Examination of differences in subscale scores of the Self-Compassion scale revealed that those who experienced sexual assault were significantly higher in self-judgment, isolation, and overidentification and marginally significantly lower in self-kindness compared to individuals who experience other types of trauma. Implications for refined treatment approaches involving the inclusion of self-compassion inductions for women who experience sexual assault-related trauma are discussed.
... As for guilt, only one study exists looking for the effectiveness of Self-Compassion Workbook Training and guilt. As a result, increase in selfcompassion lead to decrease in guilt (Held & Owens, 2015). ...
... there are also studies that could not find any effect of match on therapy effectiveness (Goates-Jones & Hill, 2008). Although it was found that individuals do not care about the statistical effectiveness of the therapy approaches and instead value the process and the relationship (Swift & Callahan, 2010), the effectiveness of the compassion-based therapy approaches are supported in the literature both for shame (Gilbert & Procter, 2006;Johnson & O'Brien, 2013;Kelly, et al., 2014) and guilt (Held & Owens, 2015). ...
... Benzer şekilde, bir meta-analiz sonucuna göre, düşük terapiyi erken bırakma oranları ve yüksek terapi etkililiğinin beklentilerin karşılanmasıyla ilişkili olduğu bulunmuştur (Swift ve ark., 2011). Danışanlar terapilerin etkililiğine dair istatistiksel verileri önemsemeyip daha çok sürece ve ilişkiye değer verseler de (Swift & Callahan, 2010), şefkat odaklı terapi yaklaşımlarının hem utanç (Gilbert & Procter, 2006;Johnson & O'Brien, 2013; Kelly, ve ark., 2014) hem suçluluk (Held & Owens, 2015) için etkili olduğu yapılan çalışmalarda gösterilmiştir. ...
The current study, comprised of two parts. The aim of the first part was to examine the relationships between maternal and paternal parental attitudes, guilt, shame, and -if any- their effects on self-compassion. 348 participants were included in the study. The paths between parental attitudes, guilt-shame, and self-compassion were analyzed through the employment of multiple mediation analyses. Both relationships of maternal and paternal acceptance/involvement with self-compassion were mediated by guilt, and the relationship between maternal strict control/supervision and self-compassion was mediated by shame. The aim of the second part was to differentiate reactions and expectations of individuals according to their guilt and shame levels. For this purpose, 2 vignettes were presented to the participants. Participants were group into four according to their guilt-shame levels. The obtained inquiry was analyzed qualitatively with Thematic Analysis. Accordingly, the emotional and behavioral reaction profiles and an overview of their expectations from others (in this thesis the focus was on the therapists) are provided. Results of both first and the second parts were discussed in the light of the literature. Moreover, strengths, implications, limitations, and suggestions for future studies were also mentioned.
Keywords: Parental Attitudes; Guilt; Shame; Self-Compassion; Thematic Analysis
... In a recent pilot study, examining the effects of a 4-weeklong self-administered SC training on trauma-related guilt among a sample of highly traumatized homeless male veterans, SC increased over the treatment period and trauma-related guilt decreased (Held and Owens 2015). Interestingly, traumarelated guilt cognitions increased slightly from pre-to midintervention assessment and dropped dramatically after. ...
... This brief incline in guilt may be explained by the treatment procedure requiring participants to become more aware of their emotions and negative self-talk, leading to a potential increased awareness of their cognitions and affective guilt in the beginning stages of treatment. However, when compared to the stress-inoculation training control group, participants in both interventions reported increased levels of SC and equal reductions in trauma-related guilt (Held and Owens 2015). Thus, more research is needed to examine under what treatment conditions SC can exert effects on trauma-related affective guilt. ...
... (Woods and Proeve 2014). However, a more relevant study examining these constructs found a large effect when examining trauma-related guilt before and after a SC intervention for trauma survivors (i.e., d = 1.56; Held and Owens 2015). Therefore, utilizing these effect size estimates, and leaning toward a conservative approach, a medium effect size estimate was selected in calculating the required sample size to achieve .95 ...
Self-compassion (SC) entails being kind toward oneself when in pain and holding painful experiences in mindful awareness, and has been associated with lower levels of posttraumatic stress severity. Recent research suggests SC may be more relevant to the current conceptualization of PTSD that is based on the DSM-5 definition, which includes a new symptom cluster focused on alterations of cognitions and mood such as guilt. We examined effects of SC on affective guilt as a function of treatment-relevant processing modes. One week after completing the SC Scale, 63 victimized women were randomly assigned to one of three processing mode induction conditions: “analytic” (brooding), “experiential” (mindful experiencing), or control. Following induction, women completed a trauma-specific perseverative thinking interview to process their trauma. Before induction (T1) and after the interview (T2), women completed a measure of affective guilt. Guilt increased from T1 to T2, and SC was negatively related to increases in guilt. Processing mode conditions moderated the relation between SC and changes in guilt; simple slopes revealed a negative relation among the analytic condition. Components of SC, including greater self-kindness and mindfulness, were related to diminished increases in guilt. Results suggest SC can buffer feelings of guilt, especially in those who process their trauma analytically. Implications for research are discussed.
... Among veterans, self-compassion is related to less worry and impulsivity (Mantzios 2014), possibly due to engagement in proactive coping, which, in turn, results in a more realistic assessment of the anxiety-provoking situation (Neff 2003b). As well, self-compassion is related to decreased trauma-related guilt, functional disability, and symptoms of PTSD among veteran samples (Dahm et al. 2015;Held and Owens 2015;Hiraoka et al. 2015). ...
... Moreover, when interpersonal needs are thwarted and a veteran may feel ostracized or like a burden, the self-kindness component of self-compassion may become of particular benefit, counteracting harsh self-critique (Neff 2003a, b). Although emerging evidence indicates that selfcompassion is linked to positive outcomes among veterans, including decreased guilt and PTSD symptoms (Dahm et al. 2015;Held and Owens 2015;Hiraoka et al. 2015), and to decreased suicidal behavior in college students (Hasking et al. 2018;Kelliher Rabon et al. 2018), the protective role of self-compassion in reducing suicide risk has yet to be investigated in veterans. Moreover, this study is one of the first to investigate whether self-compassion has more salience and, thus, more clinical utility, in times of heightened distress, particularly given the fact that veterans often face increased levels of psychosocial stressors. ...
Objectives
Veterans are at particular risk for suicide due to psychopathological, emotional, and interpersonal risk factors. However, the presence of individual-level protective factors, such as self-compassion, may reduce risk, becoming more salient at increasing levels of distress and psychopathology, per theory. We examined the relation between self-compassion and suicide risk, and the moderating effects of depression, PTSD symptoms, anger, shame, and thwarted interpersonal needs.
Methods
Our sample of US veterans (n = 541) in our cross-sectional study were mostly male (69.1%) with an average age of 49.90 (SD = 16.78), who completed online self-report measures: Suicidal Behaviors Questionnaire-Revised, Multidimensional Health Profile-Psychosocial Functioning Screening Tool, PTSD Checklist-Military Version, Differential Emotions Scale-IV, and the Interpersonal Needs Questionnaire.
Results
The linkage between self-compassion and suicidal behavior in our veteran sample was moderated by distress-evoking risk factors, including depression, anger, shame, and thwarted interpersonal needs, such that, as level of risk severity increases, the inverse association between self-compassion and suicidal behavior is strengthened.
Conclusions
Our findings highlight an emergent protective process that may prevent suicide in times of distress. Therapeutically bolstering the ability for self-compassion may provide a proactive coping strategy that can be brought to bear in times of crisis, reducing suicide risk for veterans.
... Growing research shows that MSC and other compassionrelated interventions improve PTSD (Au et al., 2017;Serpa et al., 2021) and depressive symptoms (Egan et al., 2022;Ferrari et al., 2019), as well as shame (Valdez & Lilly, 2016;Winders et al., 2020). Similar findings have also been observed within armed service or veteran samples that are predominantly male (Held & Owens, 2015;Klich, 2016;Lang et al., 2019), including within a programme evaluation of MSC (Serpa et al., 2021). For instance, a recent randomized controlled trial within veterans observed loving-kindness meditation (a practice taught in MSC) to be noninferior to Cognitive Processing Therapy (CPT) for reducing PTSD symptoms, and to yield greater improvements in depression (83% men) (Kearney et al., 2021). ...
Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue.
Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4).
Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8).
Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing.
Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.
... Indeed, the buffering impact of selfforgiveness on the development of SBI following PMIEs underscored the virtues of this resource. For example, self-compassion interventions might provide veterans the much-needed support to explore the nature of their PMIEs, which eventually may reduce guilt and shame, recognized as facilitators of PTSD and SIB following PMIEs (Held & Owens, 2015). Modeling self-compassion, preferably within a group of fellow veterans, might be a critical element in the personal journey of each young veteran to improve their ability to forgive themselves and others, thus providing more protection from greater suicide risk. ...
Background: Exposure to potentially morally injurious events (PMIEs) during military service has been associated with heightened trauma-related guilt levels, which in turn, could increase suicide risk among combat veterans. However, no longitudinal study has established temporal associations between these variables while examining a Moderated mediation model with self-forgiveness as a possible moderator of the PMIEs–suicide risk links during the first year following discharge. Method: Participants were 374 active-duty Israeli combatants who participated in a 5-year longitudinal study with three measurement points: 1 month before discharge from army service (T1), then 6 months (T2), and 12 months (T3) following their discharge. Data were assessed through semistructured interviews and validated self-report questionnaires. Results: All PMIE dimensions at T1 were negatively associated with self-forgiveness at T1 and positively associated with levels of trauma-related guilt at T2 and suicide risk at T3. Our longitudinal moderated mediation model findings indicate that, among those reporting low levels of self-forgiveness, higher levels of PMIE-Self and PMIE-Others at T1 contribute to trauma-related guilt levels at T2, which, in turn, are linked to a higher suicide risk at T3 among those reporting low levels of self-forgiveness. Conclusions: Experiencing PMIEs, especially PMIE-Self and PMIE-Other, proved to be validated predictors of trauma-related guilt and, in turn, of suicide risk during the first year after the veterans’ discharge. Combatants at their discharge from the military should have access to targeted self-forgiveness interventions, as these interventions can have a buffering effect on the development of suicidal ideation and behaviors following PMIEs.
... Emerging evidence has demonstrated the efficacy of using SC interventions for PTSD in veterans (Eaton et al., 2020). For example, Held and Owens (2015) revealed a SC workbook increased levels of SC and decreased trauma-related guilt, Hiraoka et al. (2015) found SC was negatively associated with PTSD symptoms among U.S. veterans, and Steen et al. (2021) recent review revealed SC reduced PTSD symptoms and trauma-related guilt in veterans. ...
Objectives: The study investigated the relationship between psychological distress, alcohol use, the three fears of compassion (i.e., to self, from others, and to others), facilitators and inhibitors of compassion (self-reassurance, shame, and self-criticizing), and the three flows of compassion (to self, to others, and from others) on moral injury (MI) in military veterans. Method: A total of 127 participants (81.9% male, Mage = 51.24, SD = 13.98) completed measures of MI, psychological distress, alcohol use, shame, fears of compassion, self-criticizing and self-reassurance, and the three flows of compassion. Bivariate correlations and a hierarchical multiple regression were conducted to determine relationships between psychological distress, alcohol use, and the facets of compassion and MI, and whether psychological distress, alcohol use, and the facets of compassion predicted MI among veterans. Results: Demographic variables of younger age and lower rank alongside psychological distress, alcohol use, and the facets of compassion were all significantly related to MI in veterans. Age, rank, psychological distress, alcohol use, and the facets of compassion did not predict MI in veterans. However, shame was found to be the biggest predictor of MI in veterans, followed by lower rank. Conclusion: The study supports prior research indicating MI as a shame-based presentation with younger age and lower rank posing as risk factors for MI in veterans. Additionally, the findings indicate strong relationships between the facets of compassion and MI in veterans, highlighting the potential clinical utility of including compassion within MI-based interventions.
... Indeed, suicidal ideation is more commonly found in melancholia, and is associated with greater resistance to antidepressant medication [47,48]. Specific psychosocial interventions as well as medication may be required to alter network architectures that confer risk for cascading interactions of depressive symptoms in at-risk adults with moderate-to-severe pain [49]. ...
Housing insecurity is associated with co-occurring depression and pain interfering with daily activities. Network analysis of depressive symptoms along with associated risk or protective exposures may identify potential targets for intervention in patients with co-occurring bodily pain. In a community-based sample of adults (n = 408) living in precarious housing or homelessness in Vancouver, Canada, depressive symptoms were measured by the Beck Depression Inventory; bodily pain and impact were assessed with the 36-item Short Form Health Survey. Network and bootstrap permutation analyses were used to compare depressive symptoms endorsed by Low versus Moderate-to-Severe (Mod + Pain) groups. Multilayer networks estimated the effects of risk and protective factors. The overall sample was comprised of 78% men, mean age 40.7 years, with 53% opioid use disorder and 14% major depressive disorder. The Mod + Pain group was characterized by multiple types of pain, more persistent pain, more severe depressive symptoms and a higher rate of suicidal ideation. Global network connectivity did not differ between the two pain groups. Suicidal ideation was a network hub only in the Mod + Pain group, with high centrality and a direct association with exposure to lifetime trauma. Antidepressant medications had limited impact on suicidal ideation. Guilt and increased feelings of failure represented symptoms from two other communities of network nodes, and completed the shortest pathway from trauma exposure through suicidal ideation, to the non-prescribed opioid exposure node. Interventions targeting these risk factors and symptoms could affect the progression of depression among precariously housed patients.
... This sample size resembles those from previous studies exploring the effectiveness and/or acceptability of pilot interventions in the self-compassion and stuttering literature (e.g. Delaney, 2018;Freud et al., 2020;Held & Owens, 2015;Houtveen et al., 2022). See Tables II and III for participant data, including demographic information and self-reported support group and treatment enrolment throughout the intervention. ...
Purpose:
The primary aim of this pilot study was to determine the preliminary effectiveness of an online self-compassion intervention for improving self-compassion and quality of life in adults who stutter. A secondary aim was to determine intervention acceptability and participant satisfaction.
Method:
Participants included adults who stutter who completed an online self-compassion module once a week for six consecutive weeks. Pre- and post-intervention measures included the Self-Compassion Scale-Trait and the Overall Assessment of the Speaker's Experience of Stuttering. Participants also completed acceptability questionnaires weekly and post-intervention via quantitative and qualitative reports.
Result:
Ten participants completed all six intervention modules, as well as pre- and post-intervention measures. Participants reported increased self-compassion and improved quality of life at post-intervention, as well as high intervention acceptability with regard to delivery format, content, duration, and relevance to stuttering and daily life. Individual variation was also observed across acceptability domains.
Conclusion:
The present study provides pilot data supporting the use of online modules to increase self-compassion and decrease the negative impact of stuttering on the quality of life among adults who stutter. Future studies should employ larger sample sizes, compare outcomes to a control group, and determine if gains are maintained over time.
... However, further research to understand what interventions can be effective to reduce the distress associated with impostor feelings is still needed. Self-compassion, a psychological concept that promotes mindfulness, common humanity, and kindness toward oneself, is often used to reduce mental distress (e.g., Diedrich et al., 2014;Held & Owens, 2015). An intervention that is aimed to enhance self-compassion may be effective in reducing people's impostor feelings. ...
The present study used a latent growth curve modeling approach to (a) examine the effectiveness of a brief self-compassion intervention on reducing impostor phenomenon, maladaptive perfectionism, and psychological distress and (b) explore who would benefit more from this intervention. A total of 227 college students at a large Midwest university were randomly assigned to participate in either a 4-week brief self-compassion intervention group or a nonintervention control group. Analyses of the effectiveness of the intervention suggested the brief self-compassion intervention had significant treatment effects for reducing impostor phenomenon and maladaptive perfectionism. Moreover, this study also examined whether participants with different levels of fear of self-compassion and core self-evaluation would report different levels of treatment effectiveness. Fear of self-compassion was found to be a significant moderator of the intervention effects in reducing maladaptive perfectionism and psychological distress. Specifically, participants in the intervention group with higher levels of fear of self-compassion reported a greater decline in both maladaptive perfectionism and psychological distress over time when compared to those with lower levels of fear of self-compassion. Core self-evaluation significantly moderated the effectiveness of this intervention in reducing participants’ levels of impostor phenomenon and maladaptive perfectionism. Specifically, participants in the intervention group with lower core self-evaluation reported a greater reduction in maladaptive perfectionism over time when compared to those with higher core self-evaluation.
... Three studies did not describe whether the interventions were delivered individually or as group-based interventions (Beaumont et al., 2012;Carlyle et al., 2019;Navab et al., 2019). A total of 23 studies involved self-compassion interventions administered online; 20 of these included interventions that ran in a web browser (Beshai et al., 2020;Cândea & Szentágotai-Tătar, 2018;Eriksson et al., 2018;Fernandes et al., 2022;Gammer et al., 2020;Guo et al., 2020;Hasselberg & Overall RoB Boggiss et al. (2020); New Zealand 27 adolescents (aged 12 to 16 years) with type 1 diabetes and a moderate to high instance of disordered eating behaviors as assessed by the DEPS-R; 13.9 years; 60% -IG: Two sessions (2.5 hr per session) of a selfcompassion intervention delivered 1 week apart involving group exercises and discussions, art activities, meditations, and individual reflection exercises exploring the three components of selfcompassion and self-compassion coping tools to Depressive symptoms (PHQ-9) and anxiety (GAD-7); Pretest, posttest, and 6-month F/U; No significant between group differences in outcomes over time Unclear Held and Owens (2015); USA 27 homeless male veterans who were living in transitional housing facilities; 51.3 years; 0% -IG: A 4-week self-administered self-compassion training that involved a workbook (e.g., learning ...
Objectives.
A growing body of evidence shows self-compassion can play a key role in alleviating depressive symptoms, anxiety, and stress in various populations. Interventions fostering self-compassion have recently received increased attention. This meta-analysis aimed to identify studies that measured effects of self-compassion focused interventions on reducing depressive symptoms, anxiety, and stress.
Methods.
A comprehensive search was conducted within four databases to identify relevant randomized controlled trials (RCTs). The quality of the included RCTs was assessed using the Cochrane Collaboration risk-of-bias tool. Either a random-effects model or fixed-effects model was used. Subgroup analyses were conducted according to types of control groups, intervention delivery modes, and the involvement of directly targeted populations with psychological distress symptoms.
Results.
Fifty-six RCTs met the eligibility criteria. Meta-analyses showed self-compassion focused interventions had small to medium effects on reducing depressive symptoms, anxiety, and stress at the immediate posttest and small effects on reducing depressive symptoms and stress at follow-up compared to control conditions. The overall risk of bias across included RCTs was high.
Conclusions.
Fewer studies were conducted to compare effects of self-compassion interventions to active control conditions. Also, fewer studies involved online self-compassion interventions than in-person interventions and directly targeted people with distress symptoms. Further high-quality studies are needed to verify effects of self-compassion interventions on depressive symptoms, anxiety, and stress. As more studies are implemented, future meta-analyses of self-compassion interventions may consider conducting subgroup analyses according to intervention doses, specific self-compassion intervention techniques involved, and specific comparison or control groups.
... Of the four remaining studies using comparison groups, one showed an improvement in PTSD symptoms in both the compassion-based condition (imagery re-scripting) and the traditional clinical intervention condition (imaginal exposure) with a slightly larger improvement in the traditional intervention condition (Hoffart et al., 2015). The remaining three showed a nonsignificant improvement (Beaumont et al., 2012(Beaumont et al., , 2016Held & Owens, 2015), although these used small sample sizes and were therefore potentially underpowered, giving rise to type II errors. Of the four studies without a control group, three found a significant reduction in PTSD symptoms following compassion-based interventions (Au et al., 2017;Kearaney et al. 2013;Muller-Engelmann et al., 2019). ...
Complex post-traumatic stress disorder (CPTSD) may develop following interpersonal and cumulative traumatic events, usually during early development. In addition to the core PTSD symptom profile, CPTSD presents emotional dysregulation symptoms that can be resistant to conventional treatments. Compassion-focused therapy (CFT) may be an effective intervention for addressing the more resistant symptoms in the emotional stabilisation phase of treatment rather than the trauma-processing phase. This paper explores the diagnostic validity and prevalence of CPTSD, treatment recommendations and the role of CFT in mediating shame and stabilising emotional dysregulation. We also evaluate current evidence utilising compassion-based interventions for the components of the CPTSD symptom profile and the viability of CFT as a whole. The novelty of CPTSD as a clinical condition means there is limited evidence regarding recommended treatment. Research into the efficacy of CFT and its suitability to target CPTSD’s symptom profile will contribute to the current gap in recommended treatment approaches for this condition.
... Another pilot study evaluated the effect of self-compassion therapy compared with stress inoculation on trauma-related guilt and PTSD severity. 47 The authors randomised 47 US veterans living in transitional housing to receive workbooks on the different therapies. Symptoms of PTSD did not significantly differ between the two groups after treatment. ...
Objectives
The goals of this study are to identify and analyse interventions that aim to treat post-traumatic stress disorder (PTSD) and complex PTSD in people who are vulnerably housed and to describe how these treatments have been delivered using trauma-informed care.
Design
Scoping review.
Search strategy
We searched electronic databases including MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science and PTSDpubs for published literature up to November 2021 for any studies that examined the treatment of PTSD in adults who were vulnerably housed. Websites of relevant organisations and other grey literature sources were searched to supplement the electronic database search. The characteristics and effect of the interventions were analysed. We also explored how the interventions were delivered and the elements of trauma-informed care that were described.
Results
28 studies were included. We identified four types of interventions: (1) trauma focused psychotherapies; (2) non-trauma psychotherapies; (3) housing interventions and (4) pharmacotherapies. The trauma-informed interventions were small case series and the non-trauma focused therapies included four randomised controlled trials, were generally ineffective. Of the 10 studies which described trauma-informed care the most commonly named elements were physical and emotional safety, the experience of feeling heard and understood, and flexibility of choice. The literature also commented on the difficulty of providing care to this population including lack of private space to deliver therapy; the co-occurrence of substance use; and barriers to follow-up including limited length of stay in different shelters and high staff turnover.
Conclusions
This scoping review identified a lack of high-quality trials to address PTSD in people who are vulnerably housed. There is a need to conduct well designed trials that take into account the unique setting of this population and which describe those elements of trauma-informed care that are most important and necessary.
... Another pilot study evaluated the effect of self-compassion therapy compared to stress inoculation on trauma-related guilt and PTSD severity. [46] The authors randomized 47 US veterans living in transitional housing to receive workbooks on the different therapies. Symptoms of PTSD did not significantly differ between the two groups after treatment. ...
Objectives: The goals of this study are to identify and analyse interventions that aim to treat Post Traumatic Stress Disorder (PTSD) and complex PTSD in individuals who are vulnerably housed and to describe how these treatments have been delivered using trauma-informed care.
Design: Scoping review
Search strategy: We searched electronic databases including MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science, and PTSDpubs for published literature up to March 2020 for any studies that examined the treatment of PTSD in adults who were vulnerably housed. Websites of relevant organizations and other grey literature sources were searched to supplement the electronic database search. The characteristics and effect of the interventions were analyzed. We also explored how the interventions were delivered and the elements of trauma-informed care that were described.
Results: 26 studies were included. We identified four types of interventions: (1) trauma focused psychotherapies; (2) non-trauma psychotherapies; (3) housing interventions; and (4) pharmacotherapies. The trauma-informed interventions were small case series and the non-trauma focused therapies included four randomized controlled trials, were generally ineffective. Of the ten studies which described trauma-informed care the most commonly named elements were physical and emotional safety, the experience of feeling heard and understood, and flexibility of choice. The literature also commented on the difficulty of providing care to this population including lack of private space to deliver therapy; the co-occurrence of substance use; and barriers to follow-up including limited length of stay in different shelters and high staff turnover.
Conclusions: This scoping review identified a lack of high-quality trials to address PTSD in the vulnerably housed. There is a need to conduct well designed trials that take into account the unique setting of this population and which describe those elements of trauma-informed care that are most important and necessary.
... Second, MBIs target mechanisms and risk processes implicated in trauma recovery or the buffering of chronic stress. These include metacognitive processes such as decentering (Bernstein et al., 2015;Shoham et al., 2017;Teasdale et al., 2002); executive functions such as inhibitory control in working memory or attentional control ( Jha et al., 2017;Teper et al., 2013); emotion-regulation skills, including interoceptive awareness, acceptance, and reduced reactivity (Gu et al., 2015;Held & Owens, 2015;Lindsay & Creswell, 2017); and adaptive/maladaptive self-referentiality, including reduced perseverative negative thinking (Gu et al., 2015;Van Der Velden et al., 2015) and enhanced self-compassion (Garland et al., 2015;Germer & Neff, 2015;Winders et al., 2020). Note that a number of these targeted processes are thought to transcend culture (e.g., attention, executive functions, awareness; Kabat-Zinn, 2019; Thupten, 2019). ...
Refugees and asylum seekers often suffer from trauma- and stress-related mental health problems. We thus developed mindfulness-based trauma recovery for refugees (MBTR-R)—a 9-week, mindfulness-based, trauma-sensitive, and socioculturally adapted group intervention for refugees and asylum seekers. We conducted a randomized waitlist-control study to test its efficacy and safety among a community sample of 158 Eritrean asylum seekers (46.2% female) with severe trauma history and chronic postmigration stress. Relative to the waitlist-control group, MBTR-R participants demonstrated significantly reduced rates and symptom severity of posttraumatic stress disorder, depression, anxiety, and multimorbidity at postintervention and 5-week follow-up. Therapeutic effects were not dependent on key demographics, trauma history severity, or postmigration living difficulties. Finally, there was no evidence of adverse effects or lasting clinically significant deterioration in monitored outcomes. The brief intervention format, group-based delivery, and limited attrition indicate that MBTR-R may be a feasible, acceptable, readily implemented, and scalable mental health intervention for refugees and asylum seekers.
... Few studies have directly examined SC treatment with veterans; however, preliminary findings suggest that SC is a modifiable and teachable skill among veteran and nonveteran samples. For example, one study examined the effects of a four-week self-administered SC group training on trauma-related guilt in comparison to a stress-inoculation control group in 47 homeless male veterans (Held & Owens, 2015). Participants in both interventions reported increased levels of SC and equal reductions in trauma-related guilt. ...
Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) following combat exposure affects a significant proportion of military veterans. Guilt and shame are common to PTSD-SUD, suggesting a possible role as a mechanism underlying both disorders. Cultivating self-compassion (SC) among veterans is a logical approach to treating guilt and shame. The purpose of this article is threefold: (a) present scientific theories of SC in the veteran population with emphasis on PTSD, substance use, and guilt and shame; (b) present a case study that highlights how self-compassion-focused treatment (SCFT) can be utilized in a group format with veterans with PTSD-SUD and posttraumatic guilt; and (c) discuss implications of our findings for refining SCFT within a group intervention setting among this population and for future research.
... Compassion-based interventional studies with veterans have also been very limited. A small study with homeless veterans found improvements in trauma-related guilt after completion of a self-directed self-compassion workbook (Held and Owens 2015). And in a small random controlled trial with 14 veterans in the compassion intervention arm receiving Cognitively-Based Compassion Training, participants had greater reduction in PTSD symptom severity compared with a relaxation-based active control (Lang et al. 2019). ...
Objectives
This pilot study explores the impact of Mindful Self-Compassion (MSC) in veterans. Self-compassion, the capacity to hold one’s suffering with kindness and a wish to alleviate it, is associated with improvements in well-being. Veterans have more medical conditions than non-veterans and higher prevalence rates of severe pain. Acceptability of the intervention with veterans is assessed along with the impact of MSC on the physical, mental, and social health of the participants.
Methods
A racially diverse, predominantly male group of veterans (n = 80) were assessed pre- and post-MSC group with the Patient-Reported Outcomes Measurement Information System (PROMIS) to evaluate physical, mental, and social health. Measures of self-compassion, happiness, self-report medication usage, and a global assessment of improvement measure were also included. Qualitative responses to the MSC program were also solicited and reviewed.
Results
Engagement with MSC was high (74% completion rate) and 96% of treatment completers rated their participation in the intervention as positive. Completers demonstrated small to medium effect size increases in self-compassion, happiness, and social role satisfaction, 95% CIs (− 6.13, − 2.65), (− 2.62, − 1.06), and (− 4.28, − 1.05), and decreases in depression, anxiety, fatigue, and pain interference, 95% CIs (0.44, 4.13), (0.57, 4.84), (0.43, 3.71), and (0.13, 2.70). In exploratory analyses related to pain, veterans taking pain medication reported a significant decrease in use (χ²(2, N = 47) = 24.30, p < .001).
Conclusions
These results are suggestive of the positive effects of the MSC intervention to veterans, but await a randomized controlled trial to establish its effectiveness in this population.
... The focus deliberately is to not deal first with effects, such as addressing depression or self-medication to dull emotional pain, but instead to address the event of losing one's home. Two examples that addressed the effects following trauma are from Held and Owens (2015), who focused on treatment of trauma-related guilt after rendering military service, and Helfrich, Peters, and Chan (2010), who advocated treatment for PTSD symptoms (intrusion, avoidance, and hyperarousal) following a history of childhood abuse. Examples of authors advocating interventions on the psychological effects of events include, for example, Burns (2003), who suggests treating the disabilities that have occurred in women who have been abused. ...
The purpose of this article is to begin applying the principles of the psychology of forgiveness to people who are without homes and people who are in prisons. A review of the literature shows trauma for both groups. When the trauma is caused by unjust treatment by others, then excessive anger can result, compromising one’s psychological and physical health. We review the interventions which have been offered for those without homes and the imprisoned to examine which existing programs address such anger. Forgiveness Therapy, although untried in these two settings, may be one beneficial approach for substantially reducing unhealthy anger. Forgiveness interventions have shown a cause-and-effect relationship between learning to forgive and overcoming psychological compromise such as strong resentment and clinical levels of anxiety and depression. The literature review here suggests that Forgiveness Therapy for those without homes and the imprisoned may be a new and important consideration for ameliorating anger and aiding in a changed life-pattern.
... Second, MBIs target mechanisms and risk processes implicated in trauma recovery or the buffering of chronic stress. These include metacognitive processes such as decentering (Bernstein et al., 2015;Shoham et al., 2017;Teasdale et al., 2002); executive functions such as inhibitory control in working memory or attentional control ( Jha et al., 2017;Teper et al., 2013); emotion-regulation skills, including interoceptive awareness, acceptance, and reduced reactivity (Gu et al., 2015;Held & Owens, 2015;Lindsay & Creswell, 2017); and adaptive/maladaptive self-referentiality, including reduced perseverative negative thinking (Gu et al., 2015;Van Der Velden et al., 2015) and enhanced self-compassion (Garland et al., 2015;Germer & Neff, 2015;Winders et al., 2020). Note that a number of these targeted processes are thought to transcend culture (e.g., attention, executive functions, awareness; Kabat-Zinn, 2019; Thupten, 2019). ...
Refugees and asylum seekers often suffer from trauma- and stress-related mental health problems. We thus developed Mindfulness-Based Trauma Recovery for Refugees (MBTR-R) – a 9-week, mindfulness-based, trauma-sensitive and socio-culturally adapted, group intervention for refugees and asylum seekers. We conducted a randomized waitlist-control study testing its efficacy and safety among a community sample of 158 Eritrean asylum seekers (46.2% female) with a severe trauma history and chronic post-migration stress. Relative to waitlist-controls, MBTR-R demonstrated significantly reduced rates and symptom severity of PTSD, depression, anxiety and multi-morbidity at post-intervention and 5-week follow-up. Therapeutic effects were not dependent on key demographics, trauma history severity, or post-migration living difficulties. Finally, there was no evidence of adverse effects or lasting clinically significant deterioration in monitored outcomes. The brief intervention format, group-based delivery, and limited attrition indicate that MBTR-R may be a feasible, acceptable, readily implemented and scalable mental health intervention for refugees and asylum seekers.
... Homelessness, often an indicator of housing affordability and socioeconomic stress (Thomas 2012), is a chronic stressor that may contribute to the pervasiveness of psychological distress (Lippert and Lee 2015). A previous study with homeless veterans randomized to selfcompassion and stress inoculation trainings found both interventions effective in reducing levels of post-traumatic stress disorder (Held and Owens 2015). Our analysis revealed that CBCT may work better than a support-based group for homeless individuals in terms of lowering their levels of suicidal ideation, showing the potential utility of this intervention for a highly underserved and distressed population. ...
Objectives
Both cognitively based compassion training (CBCT) and support-based group intervention have been found to be effective for African American suicide attempters in reducing suicidal ideation and depression, as well as enhancing self-compassion. This study aims to further our understanding of effective interventions by exploring participants’ responses to both interventions.
Methods
Exploratory analyses were conducted in a sample of low-income African Americans who had attempted suicide (n = 82) to determine how baseline demographic and psychological characteristics would (1) predict outcomes (i.e., suicidal ideation, depression, and self-compassion) regardless of intervention conditions and (2) moderate outcomes in interaction with intervention condition.
Results
Non-reactivity, a mindfulness facet, was identified as an intervention moderator for suicidal ideation and depressive symptoms, suggesting that CBCT outperformed the support group for African American suicide attempters who had low baseline non-reactivity (or high reactivity). Individuals who had high non-reactivity at baseline appeared to benefit more from both conditions in self-compassion as an outcome. There was a pattern that homeless individuals benefited less in terms of their levels of depressive symptoms and self-compassion as outcomes regardless of the assigned condition. When applying Bonferroni corrections, only non-reactivity as an intervention moderator for depressive symptoms was significant.
Conclusions
Findings reveal the relevance of mindfulness and to a lesser extent socioeconomic status in informing compassion-based intervention outcomes with this underserved population and the importance of intervention matching and tailoring to maximize treatment effects. Future large trials are needed to replicate findings and directions indicated from the current pilot study.
... Interventions that teach individuals to be more self-compassionate have shown promise in increasing self-compassionate attitudes (Neff & Germer, 2013) and reducing negative mental health symptoms (Kearney et al., 2013) among veterans. Lastly, although selfcompassion interventions have yet to be tested among veterans exposed to morally injurious experiences, self-compassion has shown to be efficacious in related constructs, such as trauma-related shame (Müller-Engelmann et al., 2018) and guilt among veterans (Held & Owens, 2015), both of which are considered to be important drivers in moral injury (Vermetten & Jetly, 2018). ...
Introduction:
Military veterans are at heightened risk for developing mental and behavioral health problems. Morally injurious combat experiences have recently gained empirical and clinical attention following the increased rates of mental and behavioral health problems observed in this population.
Objective:
Extending extant research, the current investigation assessed the relationship between morally injurious experiences and mental and behavioral health outcomes. Furthermore, it examined the potential protective role of self-compassion in these relationships.
Method:
Participants were 203 military veterans (M age = 35.08 years, 77.30% male) who completed online questionnaires.
Results:
Analyses indicated that self-compassion significantly moderated the relationship between exposure to morally injurious experiences and posttraumatic stress disorder, depression severity, and deliberate self-harm versatility.
Conclusions:
These results highlight the potential clinical utility of self-compassion in military mental health, particularly in the context of morally injurious experiences. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... A multiple-baselines design found that a brief compassion-focused intervention for trauma was associated with large and reliable reductions in PTSD symptomology and shame (Au et al., 2017). Case studies have demonstrated positive outcomes using CFT plus CBT or EMDR (Beaumont and Hollins-Martin, 2013;Bowyer et al., 2014;Kennedy, 2014), and controlled trials have found CFT to be as effective as CBT at reducing trauma-related distress (Beaumont et al., 2012;Held and Owens, 2015). ...
Trauma exposure and post-traumatic stress disorder are more prevalent in people with intellectual disabilities (PWID) than in the general population, yet the evidence base for trauma interventions in this population is sparse. Compassion-focused therapy (CFT) may be particularly well-suited to PWID for a number of reasons, including its adaptability to different developmental levels. PWID are more likely to have issues with self-relating (e.g. shame and self-criticism) and attachment than the general population, two issues that are compounded by trauma and which CFT explicitly seeks to address. Furthermore, compassion-focused approaches emphasize cultivating a sense of safeness while empowering people to make behavioural changes; this is particularly pertinent to PWID who have been traumatized and may feel unsafe and disempowered. An overview of CFT and its application to trauma are given, as well as some case studies using CFT with PWID.
Self-compassion is related to psychological well-being and can improve mental health problems. The present study aimed to examine the relationship of self-compassion with anxiety and depression symptoms considering the mediating effects of shame and guilt. Two hundred forty-three participants in Iran completed the measures of Depression, Anxiety, Stress Scale (DASS), self-compassion Scale-Short Form (SCS-SF), and personal feelings questionnaire-2 (PFQ-2 Brief). The result showed that there was a significant negative correlation between self-compassion and shame, guilt, depression, and anxiety. The correlation between shame and guilt with depression and anxiety was also positive and significant. Mediation analysis was used to examine whether self-compassion predicted decreased symptoms of depression and anxiety through decreased shame and guilt. The results showed that self-compassion has a negative direct effect on depression symptoms. The direct effect of self-compassion on anxiety symptoms was not significant. Moreover, we found that shame and guilt mediate the relationship between self-compassion and depressive symptoms. However, the indirect effect of guilt on anxiety symptoms was not significant. The findings of the current study demonstrate that Self-compassion is linked to more psychological strengths and efficient emotional regulations, leading to less self-conscious emotions (shame and guilt) and decreased depression and anxiety symptoms.
While possessing multiple stigmas is a common experience, research using a systematic method on this topic to quantify the total number of stigmas and their dimensions is very limited. The purpose of the current research is to examine the number and dimensions of multiple stigmas that university students experience and, moreover, to investigate whether self-compassion mediates the negative effect of multiple stigmas on resilience. Three studies (study 1: n = 476, study 2: n = 443, study 3: n = 321) were conducted in northern and southern locations of Appalachian United States, in which participants reported on their experience with multiple stigmas, self-compassion, and resilience. Depression, obesity, and poverty were the most frequently reported stigmas. Aligned with the hypotheses, the total number of multiple stigmas predicted lower resilience that was mediated by reduced self-compassion. Furthermore, after quantifying the six dimensions of stigma (disruptiveness, origin, visibility, peril, aesthetics, and persistence; Jones et al., 1984) with the taxonomy developed by Pachankis et al. (Personality and Social Psychology Bulletin, 44:451–474, 2018), our results clarified that the disruptiveness of stigma consistently predicted lower resilience, mediated by weakened self-compassion. Other dimensions had significant but less consistent relationships with resilience and self-compassion. These results contribute to the literature on multiple stigmas and thereby their associations with outcomes such as resilience. The important mediating role of self-compassion is also highlighted and underscores an important pathway between multiple stigmas and resilience, which informs our discussion on the implications for the design of prevention and intervention programs on university campuses.
The aim of the current study was to distinguish the reactions and expectations of individuals according to their guilt- and shame-proneness. For this purpose, 2 vignettes and related questions were presented to the 348 participants. Participants were grouped into four according to their guilt-shame scores (high shame-low guilt, high guilt-low shame, high guilt-high shame, low guilt-low shame). The obtained inquiry was analyzed qualitatively with Thematic Analysis. Accordingly, the emotional and behavioral reaction profiles of each group and an overview of their expectations from others are obtained. Results show that there are some specific features of each group that can be observed during interactions. For therapists, some tips are given to detect the groups of individuals easily and suggestions are provided to develop a better rapport with the clients. In addition, in the literature, always the negative effects of shame on guilt are paid attention to; however, the results of the present study provide evidence that also guilt can have a positive effect on shame. In relation to this, the combination of high guilt and high shame may not be counterproductive, and these findings may lead to new studies in the field.
Introduction
UK veterans are at increased risk of mental health and alcohol use disorders (AUDs), experiencing specific challenges such as combat exposure and re-integration which may contribute to treatment barriers. Experiences of shame and AUDs, which may precede or become exacerbated during military service, may be mitigated by self-compassion (SC). This study sought to understand how UK veterans make sense of their SC experiences within the context of their relationships with alcohol and recovery.
Methods
Interpretative phenomenological analysis was used to interpret the SC experiences of five ex-military veterans (one female). Semistructured face-to-face interviews were audio-recorded and transcribed verbatim, with a double hermeneutic approach used to interpret meaningful issues which influenced participants’ self-perceptions in relation to their alcohol use and wider social world.
Results
Two key themes were identified. ‘Searching for Safety’, which illustrated veterans’ SC sense-making within the context of their evolving lifeworld and alcohol use, and ‘Healing with Honour’ which reflected the significance of purpose and identity within experiences of recovery and SC. Findings were interpreted through the lens of the six bipolar elements of SC, which identified SC as salient within veterans’ experiences of AUD and recovery. Although experiences of SC were sometimes perceived as challenging or incongruent to military identity, this was influenced by positive reframing and meaning-making, supported by compassionate narratives and informed trusted relationships.
Conclusions
Veterans’ AUD recovery and support-seeking may be impacted by the experience of SC and enhanced by the early implementation of acceptable and feasible interventions which draw on veterans’ unique military identities and experience. This may include compassion-focussed interventions which reframe SC as fierce SC, peer support models and educational strategies which support healthcare professionals to understand and identify veterans’ military experiences.
From risk to resilience and from mental illness only to including mental well-being, a paradigm shift occurs within the field of clinical psychology. Resilience, consisting of recovery as well as sustainability and growth processes, pertains to the successful (and common) adaptation to adversity. This includes a return to baseline functioning or a new emotional equilibrium, as well as maintaining approach motivations toward personal values and goals. There is growing evidence that self-compassion is an inner resource that promotes resilience. Self-compassion aspects of mindfulness, self-kindness, and common humanity facilitate both short-term and long-term adaptation processes. Using examples of going through war (veterans) and going through cancer, this chapter illustrates how self-compassion can contribute to decreased mental distress (including anxiety and loneliness) and increased mental well-being (including emotional stability and self-care behaviors). Compassion-based interventions, both face-to-face and in online format, can contribute to facilitating resilience in the face of adversity. Future research should further investigate the different ways in which self-compassion can promote resilience, taking into account both mental distress and mental well-being aspects of mental health.KeywordsResilienceSelf-compassionMental well-beingMental distressCancerVeteransCompassion-based interventionsAdaptation
Objectives:
In this study, we analyzed the validation and effects of a brief intervention of Attachment-Based Compassion Therapy (ABCT). Specifically, the aim of this study was to assess the efficacy of this brief protocol in improving compassion and other related variables.
Method:
The intervention consists of two five-hour sessions, in a controlled trial with one intervention group (ABCT) and one control group. Before and after the intervention, a short questionnaire was administered, focused on compassion and other related variables (i.e. transcendence beliefs, happiness, endo-group solidarity, and global identity). Participants in the experimental group were 17 healthy adults (i.e., students and university teachers) attending a compassion intervention based on ABCT. The control group was composed of 44 participants who did not attend the intervention.
Results:
Results showed that, compared to the control group, the brief ABCT intervention significantly improved compassion, which was the main aim of the intervention, and further analysis showed that it also significantly increased transcendence beliefs and endo-group solidarity. Moreover, the ABCT intervention were empirically validated.
Conclusions:
These results confirm and validate the potential of a brief ABCT intervention.
This systematic review synthesizes the evidence on pretreatment patient characteristics and program features associated with treatment retention, response, and remission in military populations with posttraumatic stress disorder (PTSD).
Past research demonstrates interrelationships amongst rumination, self-compassion, and posttraumatic stress disorder (PTSD) symptoms. However, little research has considered rumination and self-compassion together in relation to PTSD in clinical populations. In this cross-sectional study, we examined the unique effect of self-compassion on PTSD beyond the effect of rumination. Secondarily, we examined if rumination mediates the effect of self-compassion on PTSD. Participants included 52 US military Veterans (73.1% male) enrolled in a community support program for PTSD who completed self-report measures of study variables at one time point. Hierarchical regression results showed rumination was related to higher PTSD scores (f² = .12; small ES) in step one, and the addition of self-compassion in step two was related to lower PTSD scores (f² = .10; small ES) and explained a unique 9% of the variance. In contrast to previous research, results showed self-compassion mediated the relationship between rumination and PTSD, with a significant indirect effect (ab) of .20 (95% confidence interval [CI] = .028 to .457). Findings suggest the explanatory value of self-compassion for PTSD after accounting for rumination and may also reflect a process where rumination about behaviors one regrets gives rise to uncompassionate responding, which then contributes to greater PTSD.
This article outlines a cognitive behavioural therapy (CBT) approach to treating feelings of guilt and aims to be a practical ‘how to’ guide for therapists. The therapeutic techniques were developed in the context of working with clients with a diagnosis of post-traumatic stress disorder (PTSD); however, the ideas can also be used when working with clients who do not meet a diagnosis of PTSD but have experienced trauma or adversity and feel guilty. The techniques in this article are therefore widely applicable: to veterans, refugees, survivors of abuse, the bereaved, and healthcare professionals affected by COVID-19, amongst others. We consider how to assess and formulate feelings of guilt and suggest multiple cognitive and imagery strategies which can be used to reduce feelings of guilt. When working with clients with a diagnosis of PTSD, it is important to establish whether the guilt was first experienced during the traumatic event (peri-traumatically) or after the traumatic event (post-traumatically). If the guilt is peri-traumatic, following cognitive work, this new information may then need to be integrated into the traumatic memory during reliving.
Key learning aims
(1) To understand why feelings of guilt may arise following experiences of trauma or adversity.
(2) To be able to assess and formulate feelings of guilt.
(3) To be able to choose an appropriate cognitive technique, based on the reason for the feeling of guilt/responsibility, and work through this with a client.
(4) To be able to use imagery techniques to support cognitive interventions with feelings of guilt.
Self-compassion, sharing some commonalities with positive psychology 2.0 approaches, is associated with better mental health outcomes in diverse populations, including workers. Due to the COVID-19 pandemic, there is heightened awareness of the importance of self-care for fostering mental health at work. However, evidence regarding the applications of self-compassion interventions in work-related contexts has not been systematically reviewed to date. Therefore, this systematic review aimed to synthesize and evaluate the utility of self-compassion interventions targeting work-related well-being, as well as assess the methodological quality of relevant studies. Eligible articles were identified from research databases including ProQuest, PsycINFO, Science Direct, and Google Scholar. The quality of non-randomized trials and randomized controlled trials was assessed using the Newcastle-Ottawa Scale and the Quality Assessment Table, respectively. The literature search yielded 3,387 titles from which ten studies met the inclusion criteria. All ten studies reported promising effects of self-compassion training for work-related well-being. The methodological quality of these studies was medium. All ten studies recruited workers in a caring field and were mostly conducted in Western countries. The Self-Compassion Scale or its short-form was used in almost all instances. Findings indicate that self-compassion training can improve self-compassion and other work-related well-being outcomes in working populations. However, in general, there is need for greater methodological quality in work-related self-compassion intervention studies to advance understanding regarding the applications and limitations of this technique in work contexts. Furthermore, future studies should focus on a broader range of employee groups, including non-caring professions as well as individuals working in non-Western countries.
Although self-compassion has been extensively studied in the recent decades, the representation of self-compassion as a unitary measure or the presence of self-warmth (i.e., presence of the positive components: self-kindness, common humanity, and mindfulness) and self-coldness (i.e., presence of the negative components: self-judgment, isolation, and mindfulness) remains controversial. Moreover, the differential effects of the six components of self-compassion on mental well-being and psychological distress have not been systematically investigated. To synthesize the differential effects of the six components of self-compassion and to examine how people in different cultures may associate the positive and negative components of self-compassion differentially, the present meta-analysis synthesized 183 effect sizes across 27 cultures. Results showed that the negative components of self-compassion (rs = 0.44 to 0.45) showed greater effect sizes with psychological distress than the positive counterparts (rs = −0.17 to −0.29) whereas the positive components of SCS (rs = 0.27 to.39) showed greater effect sizes with mental well-being than the negative counterparts (rs = −0.29 to −0.36), with the exception of common humanity and isolation (r = 0.29 and − 0.36). Cultural orientation of dialecticism moderated the association between the positive and the negative components of self-compassion, with dialectical cultures showing lower associations between the two opposing components. Findings have implications on the design and implementation of self-compassion interventions cross-culturally.
Background:
People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people.
Objective:
To identify candidate psychological and non-pharmacological treatments for future research.
Design:
Mixed-methods systematic review.
Participants:
Adults aged ≥ 18 years with a history of complex traumatic events.
Interventions:
Psychological interventions versus control or active control; pharmacological interventions versus placebo.
Main outcome measures:
Post-traumatic stress disorder symptoms, common mental health problems and attrition.
Data sources:
Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017.
Review methods:
Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist.
Results:
One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs.
Limitations:
Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented.
Conclusions:
Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder.
Future work:
Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities.
Study registration:
This study is registered as PROSPERO CRD42017055523.
Funding:
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 43. See the NIHR Journals Library website for further project information.
There is rapidly growing interest in Western compassion trainings that rely especially on traditional Buddhist practices. This growing body of research distinguishes between two distinct compassion constructs, namely self-compassion versus other-oriented compassion (hereafter, other-compassion). However, the Buddhist traditions from which most studied compassion practices derive emphasize the relevance of compassion for breaking down artificial barriers between self and other. We therefore conducted a comprehensive review of 94 randomized controlled trials on compassion training, examining how the dualistic division of compassion (into self- versus other-compassion) has shaped compassion training research to date. Our review finds patterns both consistent (e.g. a disproportionate focus on the self-oriented benefits of compassion trainings) and inconsistent (e.g. particular pairings of self-other emphasis across training and outcome) with the dualistic division of compassion. Overall, findings reveal the need for more research on social benefits of self- and other-compassion training, as well as less dualistic approaches to compassion.
Rationale:
The rate of suicide mortality among women is increasing in the United States (U.S.), especially among military veterans. Prior research suggests that important gender differences in suicide risk exist, but not enough is known to tailor prevention approaches by gender.
Objective:
The goal of this study is to understand gender differences in the development of suicidal behaviors (suicide risk) among U.S. veterans to inform future research and gender-tailored prevention efforts.
Methods:
Using a modified grounded theory approach, this qualitative study interviewed 50 (25 men, 25 women) U.S. veterans who had made a recent (prior 6 months) suicide attempt. Veterans were recruited from Veterans Health Administration (VHA) healthcare facilities across the U.S. Semi-structured, hour-long interviews examined participants' experiences with military service, suicidal thoughts and attempts, and healthcare following their attempt.
Results:
The analysis revealed two gendered narratives of suicidal thoughts and attempts that incorporated the primary themes of self-concept, social power, relationships, coping, and stress. When discussing reasons for their suicide attempts, women discussed negative self-evaluative processes describing themselves as, "shameful," "tainted," and "worthless," whereas men discussed becoming overwhelmed, and recalled thinking, "it just wasn't worth it," "I've had enough," and, "screw this."
Conclusions:
This study provides an in-depth, nuanced understanding of the gender differences in suicide risk among veterans and suggests several ways in which future work may address gender-tailored suicide prevention efforts. Specifically, women veterans may benefit from methods to increase self-worth through positive social relationships, while men veterans may benefit from methods that increase their sense of purpose in life and help them achieve their ideal selves through successful experiences.
Objectives: Self-compassion is a relatively new psychological construct, associated with better mental health outcomes in diverse populations, including workers. However, evidence relating to the applications of self-compassion interventions in work-related contexts has not been systematically reviewed to date. Therefore, this systematic review aimed to synthesise and evaluate the utility of self-compassion interventions for improving work-related wellbeing, as well as assess the methodological quality of studies conducted to date. Methods: Eligible articles were identified from academic research databases including ProQuest, PsycINFO, Science Direct, and Google Scholar. The quality of non-randomised trials and randomised controlled trials (RCTs) was assessed using the Newcastle-Ottawa Scale and the Quality Assessment Table, respectively. Results: The literature search yielded 3,387 titles from which ten studies met all of the inclusion criteria (nine non-randomised studies and one RCT). All studies reported promising effects of self-compassion training for improving work-related wellbeing. The quality of these studies was medium. All studies recruited workers in a caring field and were mostly conducted in Western countries. The Self-Compassion Scale (SCS) or its short form was used in almost all studies. Conclusions: Findings indicate that self-compassion training can improve self-compassion and other work-related wellbeing outcomes in working populations. However, in general, there is need for greater methodological quality in self-compassion intervention studies to advance understanding regarding the applications and limitations of this technique in work contexts. Furthermore, future studies should focus on a broader range of employee groups, including non-caring professions as well as individuals working in non-Western countries.
Background:
This work aimed to identify studies of interventions seeking to address mental health inequalities, studies assessing the economic impact of such interventions and factors which act as barriers and those that can facilitate interventions to address inequalities in mental health care.
Methods:
A systematic mapping method was chosen. Studies were included if they: (1) focused on a population with: (a) mental health disorders, (b) protected or other characteristics putting them at risk of experiencing mental health inequalities; (2) addressed an intervention focused on addressing mental health inequalities; and (3) met criteria for one or more of three research questions: (i) primary research studies (any study design) or systematic reviews reporting effectiveness findings for an intervention or interventions, (ii) studies reporting economic evaluation findings, (iii) primary research studies (any study design) or systematic reviews identifying or describing, potential barriers or facilitators to interventions. A bibliographic search of MEDLINE, HMIC, ASSIA, Social Policy & Practice, Sociological Abstracts, Social Services Abstracts and PsycINFO spanned January 2008 to December 2018. Study selection was performed according to inclusion criteria. Data were extracted and tabulated to map studies and summarise published research on mental health inequalities. A visual representation of the mapping review (a mapping diagram) is included.
Results:
Overall, 128 studies met inclusion criteria: 115 primary studies and 13 systematic reviews. Of those, 94 looked at interventions, 6 at cost-effectiveness and 36 at barriers and facilitators. An existing taxonomy of disparities interventions was used and modified to categorise interventions by type and strategy. Most of the identified interventions focused on addressing socioeconomic factors, race disparities and age-related issues. The most frequently used intervention strategy was providing psychological support. Barriers and associated facilitators were categorised into groups including (not limited to) access to care, communication issues and financial constraints.
Conclusions:
The mapping review was useful in assessing the spread of literature and identifying highly researched areas versus prominent gaps. The findings are useful for clinicians, commissioners and service providers seeking to understand strategies to support the advancement of mental health equality for different populations and could be used to inform further research and support local decision-making.
Systematic review registration:
Not applicable.
Self‐compassion has emerged as an important construct in the mental health literature. Although conceptual links between self‐compassion and trauma are apparent, a review has not been completed to examine whether this association is supported by empirical research findings. To systematically summarise knowledge on the association between trauma and/or posttraumatic stress disorder (PTSD) and self‐compassion. Searches were conducted in PsycINFO, PubMed, Ovid Medline, Web of Science, Embase and PILOTS databases and papers reporting a direct analysis on the relationship between these constructs were identified. The search yielded 35 studies meeting inclusion criteria. Despite considerable heterogeneity in study design, sample, measurement and trauma type, there was consistent evidence to suggest that increased self‐compassion is associated with less PTSD symptomatology and some evidence to suggest that reduced fear of self‐compassion is associated with less PTSD symptomatology. There was tentative evidence to suggest that interventions based, in part or whole, on a self‐compassion model potentially reduce PTSD symptoms. While findings are positive for the association between increased self‐compassion and reduced PTSD symptoms, the precise mechanism of these protective effects is unknown. Prospective and longitudinal studies would be beneficial in clarifying this. The review also highlighted the variability in what is and should be referred to as trauma exposure, indicating the need for further research to clarify the concept.
Homelessness continues to be a pervasive problem nationally and internationally. In the USA, the National Law Center on Poverty and Homelessness has estimated the annual number of homeless individuals to be in the range of 9.9–10.9 million sheltered and unsheltered persons, including those who have moved in with others due to financial hardship. Many of these persons suffer from severe mental illness or chronic substance abuse disorders. Additionally, many homeless persons have trauma histories, including abuse, neglect, and family and community violence. Many more have also experienced the traumatic effects of homelessness itself, including violence, revictimization, stigma, hunger, poor health, and other negative outcomes. To address the ongoing effects of traumatic stress, homelessness service settings are implementing trauma-informed care (TIC). This chapter will review the tenets of TIC and examine the personal and organizational barriers that may impede its successful implementation. Strategies for overcoming these barriers will also be highlighted.
Objectives
Self-compassion is a healthy way of relating to one’s self motivated by a desire to help rather than harm. Novel self-compassion-based interventions have targeted diverse populations and outcomes. This meta-analysis identified randomized controlled trials of self-compassion interventions and measured their effects on psychosocial outcomes.
Methods
This meta-analysis included a systematic search of six databases and hand-searches of the included study’s reference lists. Twenty-seven randomized controlled trials that examined validated psychosocial measures for self-compassion-based interventions met inclusion criteria. Baseline, post and follow-up data was extracted for the intervention and control groups, and study quality was assessed using the PRISMA checklist.
Results
Self-compassion interventions led to a significant improvement across 11 diverse psychosocial outcomes compared with controls. Notably, the aggregate effect size Hedge’s g was large for measures of eating behavior (g = 1.76) and rumination (g = 1.37). Effects were moderate for self-compassion (g = 0.75), stress (g = 0.67), depression (g = 0.66), mindfulness (g = 0.62), self-criticism (g = 0.56), and anxiety (g = 0.57) outcomes. Further moderation analyses found that the improvements in depression symptoms continued to increase at follow-up, and self-compassion gains were maintained. Results differed across population type and were stronger for the group over individual delivery methods. Intervention type was too diverse to analyze specific categories, and publication bias may be present.
Conclusions
This review supports the efficacy of self-compassion-based interventions across a range of outcomes and diverse populations. Future research should consider the mechanisms of change.
Objective
The present study investigated the associations between self‐compassion, self‐blame, disengagement coping, and posttraumatic stress disorder (PTSD) and depression symptom severity among females who had experienced sexual assault. We also examined whether the relationships between self‐compassion and both PTSD and depression severity were mediated by self‐blame and coping.
Method
A volunteer sample of female adults (N = 207) completed surveys online or on paper.
Results
Mediational analyses showed that higher self‐compassion was associated with lower behavioral self‐blame, characterological self‐blame (CSB), and disengagement coping which, in turn, were associated with less PTSD. Higher self‐compassion was associated with less depression severity directly and indirectly via CSB.
Conclusions
These findings suggest that self‐compassion may be relevant for understanding postassault mental health, partially through its associations with self‐blame and coping. Clinicians working with sexual assault survivors may choose to augment treatment‐as‐usual with interventions designed to increase self‐compassion.
Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or coresident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed.
Background/Aims/Objectives
This prospective, comparative outcome study was designed to contrast the relative impact of differing therapeutic interventions for trauma victims, carried out by the same therapist.
Methods/Methodology
A non-random convenience sample (N=32) of participants, referred for therapy following a traumatic incident, were randomly assigned to receive up to 12 sessions of either Cognitive Behaviour Therapy (CBT), or CBT coupled with Compassionate Mind Training (CMT). A repeated measures design was used and data was analysed using analysis of variance. Data was gathered pre-therapy and post-therapy, using three self-report questionnaires (Hospital Anxiety and Depression Scale; Impact of Events Scale; the Self-Compassion Scale).
Results/Findings
Results supported two of the three original hypotheses. Participants in both conditions experienced a highly statistically significant reduction in symptoms of anxiety, depression, avoidant behaviour, intrusive thoughts and hyper-arousal symptoms post-therapy. Participants in the combined CBT and CMT condition developed statistically significant higher self-compassion scores post-therapy than the CBT-only group [F(1,30)=4.657, p..05]. There was no significant difference between treatment groups.
Discussion/Conclusions
The results suggest that CMT may be a useful addition to CBT for clients suffering with trauma-related symptoms. In conclusion, high levels of self-compassion are linked to a decrease in anxiety and depression and trauma-related symptoms.
This chapter explores the role of mindfulness and compassion in the treatment of trauma. It will be suggested that unconditional caring, attunement, and acceptance, in combination with the therapist’s overall mindfulness of self and the client, can provide new experiences that support both emotional and cognitive trauma processing.
This article expands on a model that conceptualizes guilt as a multidimensional construct with affective and cognitive dimensions. In the model, guilt magnitude is a function of the magnitudes of five variables posited as primary components of guilt: distress and four interrelated beliefs about one's role in a negative event. Originally proposed to account for guilt that emerges in the context of traumatically stressful events, the model may also help account for guilt that occurs in response to common-guilt evoking events. Eight contextual variables that promote distress and activate guilt cognitions are identified, drawing attention to social or situational factors that contribute to guilt. The contextual variables are used to explain why trauma-related guilt is common and usually more chronic and severe than commonplace guilt. Initial evidence for the model is summarized and directions for future research discussed.
Ninety-nine veterans receiving treatment in a residential program for posttraumatic stress disorder (PTSD) were assessed to determine changes in maladaptive cognitions, anger expression, PTSD, and depression after receiving cognitive therapy. Veterans completed the Cognitive Distortions Scale (CDS), Trauma-Related Guilt Inventory, Beck Depression Inventory-II, State-Trait Anger Expression Inventory-2, and PTSD Checklist-Military. Paired samples t tests indicated significant differences from pre- to posttreatment for PTSD, depression, and CDS subscales. A hierarchical linear regression was conducted to determine predictors of posttreatment PTSD severity. Significant predictors were pretreatment cognitions related to wrongdoing and hopelessness and the interaction between anger expression and pretreatment PTSD severity. The interaction indicated that low pretreatment anger was associated with lower levels of posttreatment PTSD as baseline levels of PTSD severity increased.
The article describes the development and psychometric evaluation of the Trauma-Related Guilt Inventory (TRGI). An initial questionnaire was constructed from multiple sources of information. Three factor analytic studies were conducted to refine the TRGI and determine its factor structure, which consists of a Distress factor and three cognitive factors, Hindsight-Bias/Responsibility, Wrongdoing, and Lack of Justification. The TRGI has high internal consistency and adequate temporal stability. In validity studies with Vietnam veterans and battered women, TRGI scales and subscales were significantly correlated with other measures of guilt and with measures of posttraumatic stress disorder (PTSD), depression, and other indexes of adjustment. Findings support the conceptualization of trauma-related guilt as a multidimensional construct and highlight the role of cognitions in the experience of guilt and posttrauma psychopathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Two studies are presented to examine the relation of self-compassion to psychological health. Self-compassion entails being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical; perceiving one’s experiences as part of the larger human experience rather than seeing them as isolating; and holding painful thoughts and feelings in mindful awareness rather than over-identifying with them. Study 1 found that self-compassion (unlike self-esteem) helps buffer against anxiety when faced with an ego-threat in a laboratory setting. Self-compassion was also linked to connected versus separate language use when writing about weaknesses. Study 2 found that increases in self-compassion occurring over a one-month interval were associated with increased psychological well-being, and that therapist ratings of self-compassion were significantly correlated with self-reports of self-compassion. Self-compassion is a potentially important, measurable quality that offers a conceptual alternative to Western, more egocentric concepts of self-related processes and feelings.
Understanding the prevalence of and risk for homelessness among veterans is prerequisite to preventing and ending homelessness among this population. Homeless veterans are at higher risk for chronic disease; understanding the dynamics of homelessness among veterans can contribute to our understanding of their health needs.
We obtained data on demographic characteristics and veteran status for 130,554 homeless people from 7 jurisdictions that provide homelessness services, and for the population living in poverty and the general population from the American Community Survey for those same jurisdictions. We calculated prevalence of veterans in the homeless, poverty, and general populations, and risk ratios (RR) for veteran status in these populations. Risk for homelessness, as a function of demographic characteristics and veteran status, was estimated by using multivariate regression models.
Veterans were overrepresented in the homeless population, compared with both the general and poverty populations, among both men (RR, 1.3 and 2.1, respectively) and women (RR, 2.1 and 3.0, respectively). Veteran status and black race significantly increased the risk for homelessness for both men and women. Men in the 45- to 54-year-old age group and women in the 18- to 29-year-old age group were at higher risk compared with other ages.
Our findings confirm previous research associating veteran status with higher risk for homelessness and imply that there will be specific health needs among the aging homeless population. This study is a basis for understanding variation in rates of, and risks for, homelessness in general population groups, and inclusion of health data from US Department of Veterans Affairs records can extend these results to identifying links between homelessness and health risks.
Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen (THS) was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test-retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with posttraumatic stress disorder (PTSD) symptoms. The psychometric properties of the THS appear to be comparable or better than longer and more complex measures of trauma exposure.
The current combat operations in Iraq and Afghanistan have involved US military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans.
We studied members of 4 US combat infantry units (3 Army units and a Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or 3 to 4 months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and posttraumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments.
Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6% to 17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23% to 40% sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.
This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including posttraumatic stress disorder, major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of healthcare services. One study that was conducted just before the military operations in Iraq and Afghanistan began found that at least 6% of all US military service members on active duty receive treatment for a mental disorder each year. Given the ongoing military operations in Iraq and Afghanistan, mental disorders are likely to remain an important healthcare concern among those serving there. Many gaps exist in the understanding of the full psychosocial effect of combat. The all-volunteer force deployed to Iraq and Afghanistan and the type of warfare conducted in these regions are very different from those involved in past wars, differences that highlight the need for studies of members of the armed services who are involved in the current operations. Most studies that have examined the effects of combat on mental health were conducted among veterans years after their military service had ended. A problem in the methods of such studies is the long recall period after exposure to combat. Very few studies have examined a broad range of mental health outcomes near to the time of subjects' deployment. Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment. We studied the prevalence of mental health problems among members of the US armed services who were recruited from comparable combat units before or after their deployment to Iraq or Afghanistan. We identified the proportion of service members with mental health concerns who were not receiving care and the barriers they perceived to accessing and receiving such care.
The long-term health consequences of war service remain unclear, despite burgeoning scientific interest. A longitudinal cohort study of a random sample of Australian Vietnam veterans was designed to assess veterans' postwar physical and mental health 36 years after the war (2005-2006) and to examine its relation to Army service, combat, and post-traumatic stress disorder (PTSD) assessed 14 years previously (1990-1993). Prevalences in veterans (n = 450) were compared with those in the Australian general population. Veterans' Army service and data from the first assessments were evaluated using multivariate logistic regression prediction modeling. Veterans' general health and some health risk factors were poorer and medical consultation rates were higher than Australian population expectations. Of 67 long-term conditions, the prevalences of 47 were higher and the prevalences of 4 were lower when compared with population expectations. Half of all veterans took some form of medication for mental well-being. The prevalence of psychiatric diagnoses exceeded Australian population expectations. Military and war service characteristics and age were the most frequent predictors of physical health endpoints, while PTSD was most strongly associated with psychiatric diagnoses. Draftees had better physical health than regular enlistees but no better mental health. Army service and war-related PTSD are associated with risk of illness in later life among Australian Vietnam veterans.
This study examined factors associated with lifetime experience of homelessness among young adults.
Data were analyzed for 14,888 young adults (mean+/-SD age 21.97+/-1.77; 7,037 men and 7,851 women) who participated in the National Longitudinal Study of Adolescent Health (Add Health), a U.S. nationally representative, population-based sample. Data were collected from young adults through computer-assisted interviews six years after they had enrolled in the study as adolescents. Variables that have been associated with lifetime homelessness in at least one service sample were mapped to Add Health survey items. Data were analyzed by logistic regression.
A total of 682 respondents (4.6%) were classified as ever being homeless. Several factors related to childhood experiences of poor family functioning, socioeconomic disadvantage, and separation from parents or caregivers were independently associated with ever being homeless. Other significant independent factors included current socioeconomic difficulty, mental health problems, and addiction problems. Indicators of involvement in crime and addiction problems with gambling and alcohol were not independently associated with homelessness.
The findings underscore the relationship between specific indicators of adversity in childhood and risk of homelessness and point to the importance of early intervention efforts. Consistent with the extant research literature, mental health problems also appear to be associated with homelessness, highlighting the potentially complex service needs of this population.
This research examined self-compassion and self-esteem as they relate to various aspects of psychological functioning. Self-compassion entails treating oneself with kindness, recognizing one's shared humanity, and being mindful when considering negative aspects of oneself. Study 1 (N=2,187) compared self-compassion and global self-esteem as they relate to ego-focused reactivity. It was found that self-compassion predicted more stable feelings of self-worth than self-esteem and was less contingent on particular outcomes. Self-compassion also had a stronger negative association with social comparison, public self-consciousness, self-rumination, anger, and need for cognitive closure. Self-esteem (but not self-compassion) was positively associated with narcissism. Study 2 (N=165) compared global self-esteem and self-compassion with regard to positive mood states. It was found that the two constructs were statistically equivalent predictors of happiness, optimism, and positive affect. Results from these two studies suggest that self-compassion may be a useful alternative to global self-esteem when considering what constitutes a healthy self-stance.
Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or co-resident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed.
The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.
Research indicates that exposure to traumatic stressors and psychological trauma is widespread. The association of such exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. However, epidemiologic research increasingly suggests that exposure to these events is related to increased health care utilization, adverse health outcomes, the onset of specific diseases, and premature death. To date, studies have linked traumatic stress exposures and PTSD to such conditions as cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, chronic fatigue syndrome, musculoskeletal disorders, and other diseases. Evidence linking cardiovascular disease and exposure to psychological trauma is particularly strong and has been found consistently across different populations and stressor events. In addition, clinical studies have suggested the biological pathways through which stressor-induced diseases may be pathologically expressed. In particular, recent studies have implicated the hypothalamic-pituitary-adrenal (HPA) and the sympathetic-adrenal-medullary (SAM) stress axes as key in this pathogenic process, although genetic and behavioral/psychological risk factors cannot be ruled out. Recent findings, indicating that victims of PTSD have higher circulating T-cell lymphocytes and lower cortisol levels, are intriguing and suggest that chronic sufferers of PTSD may be at risk for autoimmune diseases. To test this hypothesis, we assessed the association between chronic PTSD in a national sample of 2,490 Vietnam veterans and the prevalence of common autoimmune diseases, including rheumatoid arthritis, psoriasis, insulin-dependent diabetes, and thyroid disease. Our analyses suggest that chronic PTSD, particularly comorbid PTSD or complex PTSD, is associated with all of these conditions. In addition, veterans with comorbid PTSD were more likely to have clinically higher T-cell counts, hyperreactive immune responses on standardized delayed cutaneous hypersensitivity tests, clinically higher immunoglobulin-M levels, and clinically lower dehydroepiandrosterone levels. The latter clinical evidence confirms the presence of biological markers consistent with a broad range of inflammatory disorders, including both cardiovascular and autoimmune diseases.
Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraq war has posed a considerable PTSD risk, but the association with physical health has not been well studied.
The authors studied 2,863 soldiers using standardized self-administered screening instruments 1 year after their return from combat duty in Iraq.
Among all participants, 16.6% met screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after control for being wounded or injured.
The high prevalence of PTSD and its strong association with physical health problems among Iraq war veterans have important implications for delivery of medical services. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns should be evaluated for PTSD.
Five studies investigated the cognitive and emotional processes by which self-compassionate people deal with unpleasant life events. In the various studies, participants reported on negative events in their daily lives, responded to hypothetical scenarios, reacted to interpersonal feedback, rated their or others' videotaped performances in an awkward situation, and reflected on negative personal experiences. Results from Study 1 showed that self-compassion predicted emotional and cognitive reactions to negative events in everyday life, and Study 2 found that self-compassion buffered people against negative self-feelings when imagining distressing social events. In Study 3, self-compassion moderated negative emotions after receiving ambivalent feedback, particularly for participants who were low in self-esteem. Study 4 found that low-self-compassionate people undervalued their videotaped performances relative to observers. Study 5 experimentally induced a self-compassionate perspective and found that self-compassion leads people to acknowledge their role in negative events without feeling overwhelmed with negative emotions. In general, these studies suggest that self-compassion attenuates people's reactions to negative events in ways that are distinct from and, in some cases, more beneficial than self-esteem.
This article defines the construct of self-compassion and describes the development of the Self-Compassion Scale. Self-compassion entails being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical; perceiving one's experiences as part of the larger human experience rather than seeing them as isolating; and holding painful thoughts and feelings in mindful awareness rather than over-identifying with them. Evidence for the validity and reliability of the scale is presented in a series of studies. Results indicate that self-compassion is significantly correlated with positive mental health outcomes such as less depression and anxiety and greater life satisfaction. Evidence is also provided for the discriminant validity of the scale, including with regard to self-esteem measures.
An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello
This article defines and examines the construct of self-compassion. Self-compassion entails three main components: (a) self-kindness—being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical, (b) common humanity—perceiving one's experiences as part of the larger human experience rather than seeing them as separating and isolating, and (c) mindfulness—holding painful thoughts and feelings in balanced awareness rather than over-identifying with them. Self-compassion is an emotionally positive self-attitude that should protect against the negative consequences of self-judgment, isolation, and rumination (such as depression). Because of its non-evaluative and interconnected nature, it should also counter the tendencies towards narcissism, self-centeredness, and downward social comparison that have been associated with attempts to maintain self-esteem. The relation of self-compassion to other psychological constructs is examined, its links to psychological functioning are explored, and potential group differences in self-compassion are discussed.
Self-compassion is a self-attitude construct derived from Buddhist psychology (Neff, 2003a). It entails being kind rather than harshly critical toward oneself, perceiving one's experiences as part of the larger human experience, and holding painful feelings in mindful awareness. Given that self-compassion is an Asian construct, this study compares self-compassion levels in the United States, Thailand, and Taiwan. Results indicate that self-compassion is highest in Thailand and lowest in Taiwan, with the United States falling in between. Interdependence is linked to self-compassion in Thailand only, whereas independence is linked to self-compassion in Taiwan and the United States. Results suggest that self-compassion levels in these societies are linked to specific cultural features rather than general East—West differences. However, self-compassion is significantly associated with well-being in all three cultures.
The wars in Iraq and Afghanistan have brought renewed attention to the needs of veterans, including the needs of homeless veterans. The Department of Veterans Affairs (VA) reported that in FY2008 it assessed more than 1,500 veterans who served in the Operation Iraqi Freedom and Operation Enduring Freedom theater of operations for participation in its Health Care for Homeless Veterans Program. Both male and female veterans have been over represented in the homeless population, and as the number of veterans increases due to these conflicts, there is concern that the number of homeless veterans could rise commensurately. The current economic downturn also has raised concerns that homelessness could increase among all groups, including veterans. Congress has created numerous programs that serve homeless veterans specifically, almost all of which are funded through the Veterans Health Administration. These programs provide health care and rehabilitation services for homeless veterans (the Health Care for Homeless Veterans and Domiciliary Care for Homeless Veterans programs), employment assistance (Homeless Veterans Reintegration Program and Compensated Work Therapy program), transitional housing (Grant and Per Diem program) as well as other supportive services. The VA also works with the Department of Housing and Urban Development (HUD) to provide permanent supportive housing to homeless veterans through the HUD-VA Supported Housing Program (HUD-VASH). In the HUD-VASH program, HUD funds rental assistance through Section 8 vouchers while the VA provides supportive services. In addition, two newly enacted programs focus on homelessness prevention through supportive services: the VA's Supportive Services for Veteran Families program and a VA and HUD homelessness prevention demonstration program.
The wars in Iraq and Afghanistan have brought renewed attention to the needs of veterans, including the needs of homeless veterans. Homeless veterans initially came to the country's attention in the 1970s and 1980s, when homelessness generally was becoming a more prevalent and noticeable phenomenon. The first section of this report defines the term "homeless veteran," discusses attempts to count homeless veterans, and presents the results of studies regarding the characteristics of homeless veterans. At the same time that the number of homeless persons began to grow, it became clear through various analyses of homeless individuals that homeless veterans are overrepresented in the homeless population. The second section of this report summarizes the available research regarding the overrepresentation of both male and female veterans, who are present in greater percentages in the homeless population than their percentages in the general population. This section also reviews research regarding possible explanations for why homeless veterans are overrepresented. In response to the issue of homelessness among veterans, the federal government has created numerous programs to fund services and transitional housing specifically for homeless veterans. The third section of this report discusses eight of these programs. The majority of programs are funded through the Department of Veterans Affairs (VA). Within the VA, the Veterans Health Administration (VHA), which is responsible for the health care of veterans, operates all but one of the programs for homeless veterans. The Veterans Benefits Administration (VBA), which is responsible for compensation, pensions, educational assistance, home loan guarantees, and insurance, operates the other. In addition, the Department of Labor operates one program for homeless veterans. Several issues regarding homelessness among veterans have become prominent since the beginning of the conflicts in Iraq and Afghanistan.
The aim of these two studies was to evaluate the effectiveness of the Mindful Self-Compassion (MSC) program, an 8-week workshop designed to train people to be more self-compassionate.
Study 1 was a pilot study that examined change scores in self-compassion, mindfulness, and various wellbeing outcomes among community adults (N = 21; mean [M] age = 51.26, 95% female). Study 2 was a randomized controlled trial that compared a treatment group (N = 25; M age = 51.21; 78% female) with a waitlist control group (N = 27; M age = 49.11; 82% female).
Study 1 found significant pre/post gains in self-compassion, mindfulness, and various wellbeing outcomes. Study 2 found that compared with the control group, intervention participants reported significantly larger increases in self-compassion, mindfulness, and wellbeing. Gains were maintained at 6-month and 1-year follow-ups.
The MSC program appears to be effective at enhancing self-compassion, mindfulness, and wellbeing.
Compassionate mind training (CMT) was developed for people with high shame and self-criticism, whose problems tend to be chronic, and who find self-warmth and self-acceptance difficult and/or frightening. This paper offers a short overview of the role of shame and self-criticism in psychological difficulties, the importance of considering different types of affect system (activating versus soothing) and the theory and therapy process of CMT. The paper explores patient acceptability, understanding, abilities to utilize and practice compassion focused processes and the effectiveness of CMT from an uncontrolled trial. Six patients attending a cognitive–behavioural-based day centre for chronic difficulties completed 12 two-hour sessions in compassionate mind training. They were advised that this was part of a research programme to look at the process and effectiveness of CMT and to become active collaborators, advising the researchers on what was helpful and what was not. Results showed significant reductions in depression, anxiety, self-criticism, shame, inferiority and submissive behaviour. There was also a significant increase in the participants' ability to be self-soothing and focus on feelings of warmth and reassurance for the self. Compassionate mind training may be a useful addition for some patients with chronic difficulties, especially those from traumatic backgrounds, who may lack a sense of inner warmth or abilities to be self-soothing. Copyright © 2006 John Wiley & Sons, Ltd.
Although veterans have been found to be at increased risk for homelessness as compared to non-veterans, it is not clear whether those who are homeless have more severe health problems or poorer outcomes in community-based supported housing. This observational study compared 162 chronically homeless veterans to 388 non-veterans enrolled in a national-supported housing initiative over a 1-year period. Results showed that veterans tended to be older, were more likely to be in the Vietnam era age group, to be male, and were more likely to have completed high school than other chronically homeless adults. There were no differences between veterans and non-veterans on housing or clinical status at baseline or at follow-up, but both groups showed significant improvement over time. These findings suggest that the greater risk of homelessness among veterans does not translate into more severe problems or treatment outcomes. Supported housing programs are similarly effective for veterans and non-veterans.
This study examined disengagement coping as a partial mediator between trauma-related guilt and severity of posttraumatic stress disorder (PTSD) in a sample of veterans (N = 175) entering residential PTSD treatment with either PTSD or subthreshold PTSD. Disengagement coping partially mediated the relationship between guilt and self-reported PTSD severity (b = .07; 95% CI = [-.003, .13]; p = .06), but did not mediate the relationship when PTSD severity was based on clinicians' ratings. These findings bolster Street, Gibson, and Holohan's (2005) contention that higher guilt-related cognitions are related to increases in the use of disengagement coping strategies, which can interfere with PTSD recovery. The findings support the importance of PTSD treatments that target reductions in guilt-related cognitions and disengagement coping strategies.
Neff's (2003a, 2003b) notion of self-compassion emphasizes kindness towards one's self, a feeling of connectedness with others, and mindful awareness of distressing experiences. Because exposure to trauma and subsequent posttraumatic stress symptoms (PSS) may be associated with self-criticism and avoidance of internal experiences, the authors examined the relationship between self-compassion and PSS. Out of a sample of 210 university students, 100 endorsed experiencing a Criterion A trauma. Avoidance symptoms significantly correlated with self-compassion, but reexperiencing and hyperarousal did not. Individuals high in self-compassion may engage in less avoidance strategies following trauma exposure, allowing for a natural exposure process.
The problem of homelessness is a pressing social and health concern ascribed to the interaction between personal, social, economic, and service system resources. The article is based on a qualitative study of the experiences of 29 homeless individuals. In-depth interviews were conducted with single adult shelter users. Analysis revealed the self to be a process that was continually developing. Participants tacitly locate their self-concepts in the past, present, and future. These time frames reflect the form and content of self. They also reveal hopes, dreams, beliefs, and understandings about self. The ways in which homelessness discredits notions of self and personal identity, and the hierarchy of identify with which homeless individuals use to cope are also examined.
The purpose of this report is to evaluate the risk of homelessness among veterans as compared to non-veterans, and to ascertain whether the exceptionally high risk of homelessness among post-Vietnam era veterans first observed in 1987 was still evident one decade later.
Data from the 1996 National Survey of Homeless Assistance Providers and Clients and the 1996 Current Population Survey were used to examine the risks of homelessness among veteran men as compared to non-veteran men, stratified by age and race.
The present results show that the cohort of veterans aged 20-34 that was most at risk in the 1980s, although no longer the youngest, still has the highest risk for homelessness. In 1996, the youngest cohort of veterans is also over-represented, but not to the extent found among young men 10 years before. Veterans over the age of 55 showed no increased risk of homelessness as compared to non-veterans.
The observed cohort effect, which demonstrates an especially high risk of homelessness among veterans of the immediate post-Vietnam era, even as they age, may reflect the continuing influence of the early problems in recruiting for the All Volunteer Force (AVF). In contrast to the national draft, which promised a fair representation of the entire population of draft-eligible young men, the AVF also had the potential to attract young men with fewer alternative opportunities.
This investigation utilized path analyses to examine the direct and indirect effects of experiences of potentially traumatic events in childhood, trauma-related guilt, and the use of avoidant coping strategies on level of PTSD symptomatology among a sample of female survivors of domestic violence. The results of this investigation indicated that individuals with more extensive histories of potentially traumatic events in childhood were more likely to report the experience of trauma-related guilt after exposure to domestic violence victimization in adulthood. Further, the path model indicated that experiencing trauma-related guilt was associated with greater use of avoidant coping strategies. Trauma-related guilt was related to increased PTSD symptomatology both directly and indirectly through the use of avoidant coping strategies. These findings highlight the importance of attending to guilt-based affective and cognitive reactions, maladaptive coping strategies, and the association between these constructs when treating survivors of relationship violence with multiple exposures to potentially traumatic events.
This study sought to investigate the efficacy of prolonged exposure, eye movement desensitization and reprocessing, and relaxation training on trait anger and guilt and on trauma-related anger and guilt within the context of posttraumatic stress disorder (PTSD) treatment. Fifteen PTSD patients completed each treatment and were assessed at posttreatment and at 3-month follow-up. All three treatments were associated with significant reductions in all measures of anger and guilt, with gains maintained at follow-up. There were no significant treatment differences in efficacy or in the proportion of patients who worsened on anger or guilt measures over the course of treatment. Between-treatment effect sizes were generally very small. Results suggest that all three treatments are associated with reductions in anger and guilt, even for patients who initially have high levels of these emotions. However, these PTSD therapies may not be sufficient for treating anger and guilt; additional interventions may be required.
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