Life-limiting chronic illnesses, including dementia and organ failure, are increasingly prevalent, resulting in progressive health decline and prolonged suffering. Compassion-facilitating interventions may cultivate self-compassion, promote better emotional coping, and enhance self-care. However, there is limited evidence regarding the effectiveness of these interventions on improving self-compassion for patients with life-limiting chronic illnesses. This scoping review aimed to provide an overview of compassion-facilitating interventions for this population to identify limitations in research and practice. Nine electronic databases were searched from inception to 12 October 2022. Data were synthesised according to the Joanna Briggs Institute guidelines. A total of 33 studies were included. The most common study type was feasibility studies (n = 14), and most of the included studies focused on advanced geriatric conditions and neurological disorders (n = 24). Most of the interventions were adapted from mindfulness-based protocols, with compassion meditation, compassionate movement, and decentering techniques being common components. The interventions demonstrated positive effects on self-compassion and appeared to be more effective in reducing psychological distress than in improving physical function. In compassion-facilitating interventions conducted among patients with life-limiting chronic illnesses, there is a need for additional research and practice to identify the most effective therapeutic approach and the process outcomes. Future studies should assess potential mechanisms driving these effects including increasing awareness and acceptance of suffering, opening up to self-care, and increasing social connectedness. Open Science Framework ( https://osf.io/62byx/ ), 5 October 2022.

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

Adults living in larger bodies (Body Mass Index > 30) often experience body weight shame, are highly self-critical, and are at increased risk for anxiety and depression. To date, there have been no RCTs examining the efficacy of Compassion-Focused Therapy (CFT) to help those experiencing body weight shame. The aim of the current study was to investigate the efficacy of CFT as a 12-session group intervention to reduce body weight shame for individuals living in larger bodies. The study used an RCT design with participants randomized to the CFT (n = 28) or waitlist control (n = 27) condition. Participants in both groups were assessed at pre- and postintervention, with the CFT group alone assessed at 3- and 6-month follow-up intervention. Both self-report and a physiological measure of parasympathetic nervous system activity were used (i.e., heart rate variability). Results indicated that CFT had a significant positive impact at postintervention compared to the control group for body weight shame (internal and external), increasing self-compassion, reducing fears of compassion (self, other, and receiving), reducing self-criticism, and reducing external shame. Although there were no significant group effects at postintervention on depression and anxiety, 66% of participants had clinical improvement on depression in the CFT group compared to 8% in the control group at postintervention. CFT did not shift baseline heart rate variability at postintervention. The evidence from this RCT supports CFT as an efficacious intervention to reduce body weight shame for individuals with obesity.

The interplay between the therapeutic relationship and experiential techniques is powerful. The whole is more than the sum of its parts. Therapeutic relationship predicts therapy outcomes, especially when this involves shared goals, agreed methods, and a strong interpersonal bond. When patients feel safely held in a therapeutic relationship, they feel more confident and willing to participate in experiential techniques. Conversely, the therapist's careful, purposeful implementation of techniques can help strengthen the therapeutic relationship. While the interplay between relationship and technique can be complicated, resulting in rupture, carefully repairing ruptures can both strengthen the relationship and increase willingness to engage with techniques. We comment on five case studies from this issue of the Journal of Clinical Psychology: In Session. We review the literature regarding this interplay between relationship and technique, summarize the case studies and lessons learned, consolidate the findings into a framework, and propose avenues for future therapy consideration and research.

There is a well-established relationship between self-criticism and depression. This cross-sectional study investigated the roles that rumination, worry, and fears of compassion for self and from others play in this relationship. Undergraduate students and community participants ( N = 417; 68% female; mean age 21.42 years [ SD = 6.45]) completed online self-report questionnaires measuring self-criticism, depression, rumination, worry, and fears of self-compassion and receiving compassion from others. It was hypothesized that self-criticism would predict depression, partially mediated by rumination and worry, and moderated by fears of compassion for self and from others. The indirect effects of self-criticism on depression through rumination and worry were found to be conditional on levels of fears of compassion for self and from others. Fears of compassion for self and from others magnified the impact of self-criticism on rumination and rumination on depression; and fears of compassion from others magnified the impact of self-criticism on worry. These findings suggest that having high fears of compassion for self and from others potentiates the effect of self-criticism and repetitive negative thinking on depression. Fears of compassion from others and for oneself should be assessed and addressed alongside phenomena such as self-criticism and rumination when working with depression.

Posttraumatic stress disorder (PTSD) is a significant issue for a substantial proportion of Australian ex-service personnel. In addition to the functional impact on individuals, PTSD can have a significant impact on intimate partner relationships. Research has demonstrated that practicing compassion and self-compassion may be an important component of psychological therapy for survivors of trauma, while also demonstrating benefits to intimate relationships. This pilot study aimed to investigate the utility of a Compassionate Mind Training intervention for ex-service personnel with PTSD and their partners. An uncontrolled, within-subjects, longitudinal design was utilized with assessment at pre-intervention, post-intervention and 3-month follow-up. Twenty-four participants attended 12 biweekly group sessions. Self-report measures of compassion, quality of life and psychological symptoms were administered at each time point. Findings demonstrated a significant reduction in fears of compassion and PTSD symptoms for ex-service personnel at 3-month follow-up and a reduction in depressive symptoms and increase in quality-of-life and social safeness at post-intervention. Additionally, significant reductions in anxiety, stress, external shame and self-criticism at 3-month follow-up were found, and couples reported significant increases in relationship satisfaction. Findings from this pilot study demonstrate promising outcomes, warranting further investigation in a larger randomized controlled trial of Compassionate Mind Training for ex-service personnel and their partners.

Compassion can be defined as a sensitivity to suffering, both in the self and others, with a motivation and commitment to alleviate and prevent this suffering. Mounting research has documented the countless benefits of compassion-based interventions. The Compassion Motivation and Action Scales (CMAS) were designed to assess motivation and action as core components of compassion and self-compassion, and to allow the measurement of changes in compassionate action over time. This study aims to examine the factor structure and psychometric characteristics of the CMAS in the Portuguese population and further expand its original study by exploring its test–retest reliability and responsiveness to change. Factor structure, internal consistency and construct validity of the Compassion for Others and Self-Compassion Scales of the CMAS were examined in 516 adult participants recruited from the general community. Test–retest reliability and responsiveness to change were tested in a sample of 112 participants enrolled in a Compassion Mind Training for Teachers (CMT-T) program as part of a larger intervention trial. Exploratory and confirmatory factor analysis results confirmed the original structure of the instrument, composed by three subscales (intention, distress tolerance and action), both for the Compassion for Others scale (12 items) and the Self-Compassion scale (18 items). The CMAS revealed good internal consistency, adequate construct validity, temporal stability and sensitivity to change. Therefore, the CMAS seems to constitute a valid and reliable instrument for the assessment of compassionate and self-compassionate motivation and action, which can be used as both a research and clinical tool.

Objective: A core aspect of compassion focused therapy (CFT) is addressing fears, blocks, and resistances (FBRs) to compassion. How CU therapists do this with clients remains unclear. This study aims to explore the perspectives of well-trained, experienced CFT therapists regarding how they work with FBRs in the context of CFT. Methods: A qualitative study was conducted. Participants were asked five open-ended questions regarding (a) their experiences of working with FBRs to compassion, (b) how they understand and formulate FBRs, (c) specific ways they address FBRs, (d) how other therapists might learn about working with FBRs, and (e) their top recommendations. A total of 64 participants completed the online questionnaire, and the qualitative data were analysed using thematic analysis. Results: The analysis produced four interrelated superordinate themes: (a) Getting "alongside" and "behind": The central role of formulation, (b) "It's not your fault": Psychoeducation, (c) "Get experiential": An emphasis on experiential interventions, and (d) "Respect the wisdom": The importance of therapeutic process. Conclusions: Working with FBRs to compassion is critical in CFT. Understanding the wisdom in the client's FBRs, and validating and de-shaming the client's FBRs are crucial. We provide clinical recommendations regarding working with FBRs as part of CFT.

Shame is a universal human emotion that influences human psychosocial functioning and development. Shame can arise in the context of grief, especially when there are difficult shame memories present for the grieving person related to the loss. In this chapter we will explore shame, its evolutionary origins and functions, associated social, cultural, and psychological factors, and the notion of shame memories, how they develop, and the form they take. Following this, we will explore shame in grief as well as approaches to assessing shame in this context. We will illustrate the key concepts presented via a clinical vignette woven throughout the chapter.

Experiential practices are a core component of compassion focused therapy (CFT). Throughout the treatment process, the client's engagement with these practices may become blocked, resulting in a rupture in the therapeutic relationship. In these instances, the interplay between these experiential practices and the therapeutic relationship becomes an essential focus of therapy to repair the rupture, re-engage the client in the therapeutic process, and proceed with the CFT treatment plan. This paper presents the case of a man diagnosed with social anxiety disorder, with the presence of shame-based self-criticism, treated via 12 sessions of CFT. CFT was proceeding well until certain embodiment practices and chair work were introduced, at which point the client refused to continue and became disengaged in the session. The process of repair and re-engagement will be discussed from the perspective of this interplay between experiential exercises and therapeutic relationships. Implications for CFT practice and clinical recommendations will be provided.

The adverse effects of childhood sexual abuse (CSA) are often significant and enduring. It is therefore important to identify therapeutic interventions that can effectively minimize these effects. Compassion focused therapy (CFT) was originally developed for people with high levels of self-criticism and shame. It holds significant promise as an intervention for survivors of CSA, but has not yet been empirically tested. This study explored both the acceptability and preliminary efficacy of a CFT group intervention (CFT-SA) for adult female survivors of CSA. CFT-SA was developed and tested with adult female survivors of CSA, to determine if there was any change in outcome measure scores after participating in the 12-week intervention (n = 30) and at 3-month post-intervention follow-up (n = 25). Low attrition and high session attendance, in addition to positive participant feedback, suggested the program had high acceptability. Significant improvement was observed across all outcome variables from pre- to post-intervention (n = 30), which were maintained at follow-up (n = 25). Participants demonstrated increased self-compassion and self-reassurance, and reduced symptoms of post-traumatic stress, shame, and self-criticism, as well as fears of compassion, depression, anxiety, and stress, with medium to large effect sizes (d = .55 to 1.36). Across all measures, between 20 and 57% of participants demonstrated reliable change pre- to post-intervention, and 22 to 57% from pre-intervention to follow-up. This study provides preliminary support for the acceptability and potential benefits of utilizing CFT-SA as an intervention for adult female survivors of CSA and offers recommendations for future research. Trial Registration. Australian New Zealand Clinical Trials Registry, ACTRN12616001041448.

Objectives The COVID-19 pandemic is having an unprecedented detrimental impact on mental health in people around the world. It is important therefore to explore factors that may buffer or accentuate the risk of mental health problems in this context. Given that compassion has numerous benefits for mental health, emotion regulation, and social relationships, this study examines the buffering effects of different flows of compassion (for self, for others, from others) against the impact of perceived threat of COVID-19 on depression, anxiety, and stress, and social safeness. Methods The study was conducted in a sample of 4057 adult participants from the general community population, collected across 21 countries from Europe, Middle East, North America, South America, Asia, and Oceania. Participants completed self-report measures of perceived threat of COVID-19, compassion (for self, for others, from others), depression, anxiety, stress, and social safeness. Results Perceived threat of COVID-19 was associated with higher scores in depression, anxiety, and stress, and lower scores in social safeness. Self-compassion and compassion from others were associated with lower psychological distress and higher social safeness. Compassion for others was associated with lower depressive symptoms. Self-compassion moderated the relationship between perceived threat of COVID-19 on depression, anxiety, and stress, whereas compassion from others moderated the effects of fears of contracting COVID-19 on social safeness. These effects were consistent across all countries. Conclusions Our findings highlight the universal protective role of compassion, in particular self-compassion and compassion from others, in promoting resilience by buffering against the harmful effects of the COVID-19 pandemic on mental health and social safeness.

Shame is a universal emotion, albeit having a bewildering constellation of causes, valuations, and behavioural consequences that differ across social ecologies. This transdiagnostic emotion may be categorized into two distinct components: external and internal shame. The External and Internal Shame Scale (EISS) has proven to be a brief and reliable instrument to assess external and internal shame, as well as a global sense of shame. The current study aims to corroborate the validity of the EISS and expand its utility, by investigating its dimensionality and testing its measurement invariance in samples from five eclectic countries from Europe, East and Southeast Asia and Australia. Differences in EISS scores across the five countries were also explored. This cross-national study included 1405 participants recruited in community samples of adults from Portuguese, French, Australian, Singaporean and Japanese populations, who completed the EISS in four different languages. An hierarchical model with two factors (external and internal shame) loading on one global factor (global shame) revealed good fit to the data in the total sample and in each of the five countries’ samples, and the instrument showed good reliability across countries. The EISS factorial structure also proved to be invariant across countries. Differences in global shame, external and internal shame scores were found between the countries. By supporting the factorial structure, reliability and measurement invariance of the EISS across countries, this study contributes to expand the use of the EISS across nations and in different languages, both in research and clinical settings.

Objective: While motivation and action are core components of compassion and self-compassion, no other measure thoroughly assesses these aspects, or offers a measure of change in compassionate action over time. In a novel application of the language of motivation and action described in motivational interviewing theory and research, this study developed the Compassion Motivation and Action Scales (CMAS), and examined its psychometric characteristics. Method: A sample of 621 participants was recruited to conduct exploratory and confirmatory factor analyses on the CMAS for both Compassion and Self-Compassion Scales. Results: The analyses supported a factor structure of the CMAS of three subscales, Intention, Distress Tolerance, and Action, for Compassion (12-items) and Self-Compassion (18-items) Scales. The confirmatory factor analysis supported stability of the factor structures of the CMAS scales. Psychometric evaluation revealed that the CMAS scales had good internal consistency, and satisfactory construct and concurrent validity with other psychometrically valid measures of compassion and mental health. Conclusion: The CMAS offers a brief, user friendly, public domain measure of compassionate and self-compassionate motivation and action, which was psychometrically strong. Potential uses of the measure as both a research and clinical tool, and implications for further research, are discussed.

Empirical research has documented the benefits of compassion for mental health, psychosocial and physiological wellbeing. Yet, definitions of compassion vary amongst theoretical approaches, researchers, clinicians and lay people. The meaning and nature of compassion can be misunderstood and become linked to fears, blocks and resistances to compassion. The current paper defines compassion from the perspective of compassion focused therapy (CFT) and distinguishes it from other commonly related concepts, using a qualitative methodological approach. Participants' understanding of compassion was explored through their selection of the words they associated with compassion and self-compassion, and descriptions of recalled experiences of giving and receiving compassion, with cultural differences further examined. A sample of 584 adult participants was recruited from general community populations in Australia (n - 296), Portugal (n - 183) and Singapore (n - 105) and completed a self-report questionnaire assessing the meaning and the subjective experiences of compassion. Empathy, Kindness and Understanding were the three words participants most frequently associated with `Compassion'. The most frequent three words selected by participants associated with `Self-compassion' were Acceptance, Strength and Understanding. Various cultural differences among countries were identified and discussed. The findings also clarified participants' experiences of compassion for others, receiving compassion from others and self-compassion, identified similarities and differences between countries, and revealed a significant proportion of people who were unable to recollect/ describe compassion experiences (across the three flows). The findings are discussed in light of a CFT framework and clinical implications for CFT practitioners are derived.

Background Historically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people’s experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress. Methods Adult participants from the general population ( N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress. Results Perceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries. Conclusions Social connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

Objectives The objectives of this study were to explore whether avoidance and activation mediate the relationship between self-compassion and depressive symptoms. Research investigating these mechanisms may help identify potential intervention targets for preventing depression. Methods A cross-sectional survey design was employed involving 242 non-clinical Australian adults (188 females, 54 males) ranging from 18 to 76 years ( M = 24.99, SD = 9.07). Participants completed online Self-Compassion Scale, Behavioral Activation for Depression Scale, Reward Probability Index, and Depression, Anxiety, and Stress Scales. Results Avoidance and activation were found to be significant mediators of the relationship between self-compassion and depressive symptoms. This indicates that self-compassion may influence depressive symptoms through the mechanisms suggested to operate in a behavioral model of depression, specifically avoidance and activation. Conclusions These findings linking self-compassion to activation and avoidance with depressive symptoms are promising. Further research with larger, representative, non-clinical and clinical populations, as well as the collection of prospective data, could help establish the causality of these links.