Every month, we scour the scientific literature for interesting studies that have practical implications for therapists working with shame, self-criticism, or compassion. Below are a few of our favorites for this month:
Compassion Training Helps Reduce Binge Eating and Distress for People Struggling with Binge Eating Disorder
This is the first randomized controlled trial to explore the effectiveness of self-help groups based on ideas from compassion-focused therapy for people struggling with binge eating disorder (BED). The researchers randomly assigned 41 people struggling with BED to one of three groups: compassion self-help, behavioral self-help, or waitlist control. People in both self-help groups were instructed to follow a regular, planned eating schedule. In the compassion group, people were instructed to manage binge urges by imagining a time someone was compassionate towards them, imagining a time when they felt compassion towards someone else, writing a letter focused on expressing kindness for binge eating struggles, or talking to themselves from a warm and compassionate mindset. In the behavioral group, people were instructed to manage binge urges by turning to healthier alternative activities, writing about what they learned from the day’s eating and urges, and writing about what they would do similarly versus differently the following day. Individuals in both self-help groups binged half as often by the end of the three-week study. However, only individuals in the compassion group increased their self-compassion levels, and decreased their weight/shape/eating concerns. Interestingly, individuals who were fearful about becoming self-compassionate benefited the least from the compassion intervention. Only non-fearful individuals had fewer depressive symptoms and less weight/shape/eating concerns by the end of the study. Although preliminary, these results suggest that at least for people low in fear of self-compassion, the cultivation of self-compassion could be a useful addition to BED treatments, with self-compassion having the potential to not only help decrease binges, but also to reduce weight/shape/eating concerns and distress.
Take Away: First, it’s important to note that people in this study viewed both self-help treatments as equally credible and helpful. When working with individuals struggling with BED, consider including exercises aimed to increase self-compassion, such as self-compassionate imagery. This study also indicates that addressing fears of self-compassion is important for people to be able to benefit from compassion-generating interventions. People who are more self-critical and shame prone are often more fearful of self-compassion, suggesting that jumping into compassion-focused imagery too quickly may not be helpful to many clients.
Kelly, A. C., & Carter, J. C. (2015). Self‐compassion training for binge eating disorder: A pilot randomized controlled trial. Psychology and psychotherapy: Theory, research and practice, 88(3), 285-303.
Loving Kindness Meditation Helps People Struggling with Borderline Personality Disorder More than Continued Mindfulness Training
After ten weeks of mindfulness training, 32 people struggling with borderline personality disorder (BPD) were randomly assigned to either a loving-kindness and compassion meditation (LKM/CM) group, or a mindfulness continuation training (MCT) control group. In the LKM/CM group, people learned about the nature of self-compassion, and participated in exercises and meditations aimed to increase compassion (for exercise ideas, see the Mindful Self-Compassion Program and kindness and affection techniques from Dialectical Behavioral Therapy, such as half smile, willing hands, self encouragement, connectedness meditation and contribution skills). In the MCT group, people continued to practice mindfulness techniques. At the end of the three-week training program, people in both groups had significantly lower levels of self-criticism. However, only people in the LKM/CM group had pre-post improvements in BPD symptom severity, compassion, and acceptance.
Take away: Although preliminary, these results suggest that LKM/CM may be a valuable complementary therapeutic approach when working with people struggling with borderline personality disorder. Clinicians should be mindful that it might be important to address fears of self-compassion before using these techniques with some clients (see Gilbert, McEwan, Matos, & Rivis, 2011).
Feliu-Soler, A., Pascual, J.C., Elices, M., Martin-Blanco, A., Carmona, C., Cebolla, A., … & Soler, J. (2016). Fostering Self-Compassion and Loving-Kindness in Patients With Borderline Personality Disorder: A Randomized Pilot Study. Clinical psychology & psychotherapy.
People Sensitive to Criticism Attend More to Negative Information
People who think their loved ones are highly critical of them (i.e. people high in “perceived criticism”) are more likely to struggle with their mental health. It remains unclear why this is the case, so the present study examined how people high and low in self-criticism process emotional information. 76 participants completed two tasks designed to assess differences in attention to positive, negative, and neutral information. In the first task, participants identified the direction of an arrow flanked by either neutral or angry faces. While people low in perceived criticism identified the direction of the arrow equally quickly in both neutral and angry trials, people high in perceived criticism identified the direction of the arrow more slowly in angry trials. In other words, people high in perceived criticism found the negative faces distracting. In the second task, participants listened to blended words consisting of a negative and a neutral word (e.g. sad-sand). Compared to people low in perceived criticism, people high in perceived criticism identified more negative words from the ambiguous word blends. In other words, people high in perceived criticism were biased to interpret the ambiguous information as negative. Together, these results suggest that people high in PC may be biased toward attending to negative information and may be more likely to appraise ambiguous information as negative. Perhaps this attention to the negative helps explain some of the connection between PC and poor mental health outcomes.
Take Away: Researchers have reliably assessed levels of PC with one question: “How critical is your spouse of you?” As a clinician, you could ask clients, “Think of the person who you are closest to. How critical is that person of you?” and then ask them to rate how critical they are from 1 (not at all critical) to 10 (very critical). This tendency to see others are critical appears to be somewhat independent of whether others are actually critical. Thus, if the client rates that person as highly critical, you may expect to see a bias toward negative information and the client may tend to construe your behavior in a negative light, for example thinking you are critical or frustrated when you are not. They may also be at greater risk for poor outcome from therapy and require a great focus on the therapy alliance. For ideas on working with these kinds of difficulties, you might check out our post about I/YOU perspective taking.
Masland, S. R., Hooley, J. M., Tully, L. M., Dearing, K., & Gotlib, I. H. (2014). Cognitive-processing biases in individuals high on perceived criticism. Clinical Psychological Science, 2167702614529935.