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.
There is emerging evidence that people with both fibromyalgia and functional gastrointestinal (GI) disorders report more severe psychological symptoms than people with only fibromyalgia or a ...functional GI disorder. We use Ecological Momentary Assessment (EMA) to examine whether, for people with fibromyalgia, accompanying GI symptoms result in stronger bidirectional relationships between distress and bodily pain or fatigue.
Participants were 67 women with fibromyalgia from a study by Okifuji et al. (2011; 13), in which EMA data on pain, fatigue, and distress was collected over 30 days. Thirty-three participants reported GI symptoms at baseline, and 34 participants reported no GI symptoms but at least one other bodily symptom. Using multilevel linear regressions with interaction terms, we compared the two groups on the strength of reciprocal within-day and day-to-day relationships between pain, fatigue, and distress.
GI symptom status did not moderate relationships between distress and pain. However, participants with GI symptoms uniquely reported more distress following increased fatigue within days (b = 0.120, 95%CI: 0.041,0.198), and sharper distress escalations across days (b = 0.078 95%CI: 0.007, 0.149).
We do not find evidence of stronger bidirectional within-day and day-to-day relationships between distress and bodily symptoms in this patient group. We do, however, find evidence of heightened fatigue-related distress and escalating distress. These cyclical processes can become a focus for cognitive behavioural therapy, patient education, and physical (exercise/sleep) therapy aimed at addressing fatigue.
•We reanalyse experience sampling data on pain, fatigue and distress in fibromyalgia.•We focus on bidirectional links between distress and pain and fatigue.•We find that gastrointestinal(GI) symptoms do not moderate these links.•GI symptoms do predict greater distress following earlier distress and fatigue.•Distress and fatigue should be a focus for treatment in this patient group.
•Path modelling investigated relationships between sleep, depressive symptoms, and cognitive decline in older adults.•540 adults aged 44 years and over underwent comprehensive psychiatric, ...neuropsychological, and medical assessment.•Age, medical comorbidities and education predicted MCI diagnosis via poorer sleep and higher depressive symptomatology.•Sleep and depression are linked to cognitive decline in aging, with sleep disturbance predicting depressive symptoms.•Early detection and treatment of sleep problems in older adults may reduce depressive symptoms and MCI diagnosis.
This study examined the complex relationships between sleep quality, depressive symptoms, and cognitive decline in older adults. We hypothesised that older age, lower education and greater medical comorbidities would each be associated with increased mild cognitive impairment (MCI) diagnosis risk through indirect effects via poorer sleep quality, and greater depressive symptomology.
540 adults 44 years and over were recruited at the Brain and Mind Centre, Sydney, Australia. Participants underwent comprehensive psychiatric, neuropsychological, and medical assessment. Subjective sleep quality, current depressive symptomatology, and current medical burden were assessed.
There were significant indirect effects of each of age, comorbidities and education, that operated via both sleep and depression. Younger age, greater comorbidities and fewer years’ education each predicted greater chance of MCI diagnosis via poorer sleep and in turn higher depressive symptomatology. Additionally, there was a significant direct effect of older age on MCI.
The current study is cross-sectional and cannot determine whether poorer sleep quality and greater depressive symptomatology precede or arise as a result of the onset of cognitive decline in later-life. A longitudinal design may allow further explication of these relationships.
Both sleep and depression are linked with cognitive decline in older adults, with sleep disturbance appearing to predict depressive symptoms. These findings have implications for the management of MCI. Both greater depression symptomatology and sleep disturbance were shown to predict the risk of MCI diagnosis, with this effect strongest in those that are younger. Improved early detection and treatment of sleep problems in older adults may help prevent depressive symptom manifestation or exacerbation, in turn potentially reducing the risk of subsequent cognitive decline.
Evidence from analogue samples suggests that deficits in emotional functioning, namely elevated emotional reactivity and distress intolerance, are implicated in the development and maintenance of ...hoarding disorder. We aimed to extend previous research in this area by investigating emotional reactivity and distress intolerance in a sample of individuals diagnosed with hoarding disorder (n = 24) in comparison to clinical controls (n = 21) and nonclinical community controls (n = 26) using a combination of self-report, physiological, and behavioral measures. We found that trait distress intolerance was significantly and independently associated with greater hoarding severity. The hoarding and clinical control groups reported more trait emotional reactivity and distress intolerance than the community control group, but did not differ from each other on these traits. The hoarding group reported more subjective distress before beginning a frustrating behavioral task, but did not evidence more physiological arousal. Moreover, the hoarding group experienced similar increases in distress during the task and did not differ from either group in regard to time persisting on this task. The clinical control group, however, terminated the frustrating task significantly faster than the community control group, who tended to persist until the task timed out. Lastly, trait distress intolerance evidenced a small-to-moderate but nonstatistically significant independent relationship with task persistence time. Given the desynchrony between subjective distress and physiological arousal, we encourage researchers to utilize multimodal assessment in the future. We also suggest that clinicians start to use behavioral experiments, as has been done with other psychological disorders, to improve distress intolerance among persons who experience hoarding disorder.
•Trait distress intolerance independently predicted greater hoarding severity•Trait distress intolerance shared a small-moderate relationship with task persistence•Hoarding and clinical groups self-reported poorer trait emotional functioning•Groups did not differ on task-induced subjective or physiological reactivity•The hoarding group self-reported more distress prior to task initiation
Background
There is limited empirical evidence of the magnitude of the discrepancy between prospectively recorded gastrointestinal symptom burden and that reported in recall questionnaires. Further, ...potential sources of the discrepancy are largely unknown. This study sought to quantify the discrepancy and to evaluate the potential role of mood disorder and emotion regulation in the discrepancy.
Methods
One hundred and forty nine subjects (mean age 20 years, 75% female) who met Rome IV criteria for irritable bowel syndrome and/or functional dyspepsia completed a 7‐day prospective recording of the symptoms on a smartphone implemented ecological momentary assessment app, and then on day 8 were asked to recall their symptoms for the preceding 7 days.
Key Results
Gastrointestinal symptom burden assessed by recall was exaggerated relative to that recorded prospectively. The discrepancy was moderate for overall score (Cohen d = 0.52), abdominal pain (d = 0.61) and indigestion (d = 0.49). The discrepancy was generally larger among subjects who reported a physician diagnosis of a gastrointestinal condition with d = 0.87 for overall score and d = 0.89 for abdominal pain. A number of correlations between the discrepancy and psychological traits were identified, including neuroticism with diarrhea discrepancy (r = 0.23, p = 0.004) and visceral‐specific anxiety with abdominal pain discrepancy (r = −0.18, p = 0.03). There was no evidence of recency or Hawthorne (observer) effects.
Conclusions and Inferences
Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy.
Symptom‐induced distress may alter our memory of symptom severity.
Summary
Background
An individual’s drive to seek medical help remains a complex behavioural process, incorporating psychological, social and symptom‐specific factors. Within irritable bowel syndrome ...(IBS), gastrointestinal symptoms only predict a small portion of the high healthcare‐seeking experienced.
Aim
To examine the moderating role of quality of life (QoL) domains on this relationship to help explain the variance observed.
Methods
This is an analysis of a Swedish population‐based prospective study of healthcare use over a 12‐year period. At baseline, gastrointestinal symptoms were measured with the valid Gastrointestinal Symptom Rating Scale, and QoL via the SF‐36. 1159 subjects (57% female; mean age 48.6 years) had their health records matched with the initial survey. 164 were classified as IBS by Rome II criteria. Negative binomial or logistic models were fit to evaluate the moderating effect of particular QoL domains on the relationship between gastrointestinal symptoms and prospective healthcare utilisation.
Results
Gastrointestinal symptoms were associated with prospective healthcare use, but moderation in this relationship by particular QoL domains was not supported; most models did not reach statistical significance. Furthermore, the impact of IBS status did not alter the moderation hypotheses.
Conclusions
Particular QoL domains did not impact the relationship between gastrointestinal symptoms on prospective healthcare seeking. Future research should continue to examine other psychological, social and symptom variables to identify predictors of high healthcare consumers in IBS.
Positive association between GI symptoms and prospective healthcare utilization.Limited evidence of moderation by quality of life was identified.
Debate continues as to whether an attentional bias towards threat displayed by sufferers of functional gastrointestinal disorders (FGIDs) is conscious and, thus, more amenable to change through ...psychological therapy. We compared the amplitudes of early (unconscious) and later (conscious) electroencephalographic (EEG) event-related potentials following silent reading of symptom-related, emotionally neutral, and emotionally negative nouns across two participant groups: 30 female FGID-sufferers who met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, and 30 female healthy controls. Analogous indices based on alpha desynchronization were also examined, as were correlations between the EEG-based indices and a range of psychosocial variables. FGID-sufferers displayed marginally significantly higher occipital EPN amplitudes for all nouns, indicating marginally higher levels of unconscious attention in the task. FGID-sufferers also displayed, for negative as compared to neutral nouns, significantly lower central N400 amplitudes indicative of higher conscious attention. The result was only apparent in post-hoc pairwise comparisons, however. Uniquely among FGID-sufferers, central N400 was strongly negatively correlated with a range of negative psychosocial traits and states. The findings provide preliminary evidence of hypervigilance to general (as opposed to symptom-specific) threat among FGID-sufferers. Amidst concerns over Type I error, recommendations are made for fine-tuning the operationalisation of unconscious and conscious attentional bias in this population.
•An EEG-based approach to tracking unconscious attention (UA) to threat is piloted.•Under the approach, greater UA is indicated by higher amplitudes of the P100 and EPN.•UA was marginally higher in sufferers of IBS and functional dyspepsia than controls.•Conscious attention was also higher, as indicated by lower N400 in post-hoc analyses.•The results are tentative, as they reflect marginally significant or post-hoc results.
The objective of the present study was to test the moderating impact of an unknown pain etiology on the relationship between psychological factors and chronic pain intensity and disability.
N = 471 ...chronic pain sufferers presented to an online Cognitive Behavioral Therapy randomized control trial, known as the Pain Course. Participants' etiology was classified as medically unexplained or medically explained via interview and self-reported data. Standardized psychological measures at baseline were used in a non-hierarchical cluster analysis, which allocated chronic pain participants into mutually exclusive groups.
Four distinct clusters were identified: Psychologically healthy, mild psychological distress, high psychological distress, and average. The profile with high psychological distress experienced the greatest pain intensity (mean: 6.44 (SD = 1.66)) and disability (mean: 17.53 (SD: 3.65)). This relationship was not moderated by preceding pain etiology being medically explained or unexplained (χ2 (3) = 0.45, p = 0.93 and χ2 (3) = 7.07, p = 0.07 respectively).
These findings indicate that an unknown pain etiology has little role in altering the relationship between psychological factors and pain disability in individuals experiencing chronic pain. This suggests that the psychological association with pain disability and intensity experienced by people with medically unexplained symptoms is similar to people with medically explained symptoms.
•Four distinct psychological profiles were identified.•A strong relationship between profiles and disability was found.•Origin of pain does not moderate this relationship.
To determine whether pain-related treatment outcomes, following an online Cognitive Behavioural Therapy (CBT) intervention for chronic pain, were moderated by the pain etiology of a medically ...explained or unexplained origin.
Data were available from 471 participants who completed the online pain management program between March 2013 and August 2014. Participants' pain symptoms were classified as being medically explained symptoms (MES: n = 292) or medically unexplained symptoms (MUS: n = 222) via analysis of clinical data. Outcome variables were pain-related disability, average pain intensity, depression and anxiety.
Moderation analyses were non-significant for all dependent variables. Between group differences (CBT and control) were larger for depression in those classified with MES, compared with MUS (MUS: mean change = −3.50 95% CI = −4.98 to −2.22; MES: mean change = −5.72 95% CI = −7.49 to −4.09). However, between group differences were small for pain intensity (MUS: mean change = −0.03 95% CI = −0.83 to 0.81; MES: mean difference = −1.12 95% CI = −1.84 to 0.40).
The therapeutic outcomes examined in this study associated with an online CBT program do not appear to be altered by whether the participants' pain symptoms are medically explained or unexplained.
•Psychological therapy for chronic pain improves mood and pain-related disability.•Medically explained and unexplained symptoms benefit equally from therapy.•Addressing pain-related distress is a key component in multidisciplinary therapy.
The current study evaluated a theoretically-derived model of the relationships between psychological traits (neuroticism and mindfulness) and gastrointestinal (GI) symptom burden with indirect ...effects via general dispositional cognitions and health-related cognitions. A sample of women (
N
= 210,
M
age
= 22.83,
SD
age
= 9.78) completed an online questionnaire battery consisting of self-reported GI symptom burden, neuroticism, mindfulness, general cognitions (emotional intelligence, reappraisal, suppression, rumination), and health-related cognitions (gastrointestinal-specific anxiety, pain catastrophizing). Our hypotheses were tested using multiple regression, latent variable, and structural equational modeling. Both mindfulness (Beta = − .220,
p
= .011) and neuroticism (Beta = .234,
p
= .001) significantly independently predicted GI symptom burden. Additionally, these relationships were completely accounted for via indirect effects of general cognitions and health-related cognitions, supporting our hypotheses: Indirect effect of neuroticism on GI symptom burden: Beta = .228,
p
= .007; Indirect effect of mindfulness on symptom burden: Beta = − .308,
p
= .011. The findings from the current study highlight the important role of both general and health-related cognitions in the experience of GI symptom burden and support theoretical models that posit mechanisms of mindfulness via adaptive coping strategies. Given the subjective nature of symptom experience, these findings may help to explain the efficacy of psychological therapies in reducing GI symptom burden.
