Self-compassion has been defined by Kristen Neff (2003) as having a balanced and self-supportive approach in times of difficulty and remembering that going through difficulties is a part of the human experience. Other researchers, like Paul Gilbert (2017), emphasise that compassion involves courage to engage in suffering, and wisdom how best to act.

Self-compassion interventions include, for example, Gilbert’s Compassion Focused Therapy (CFT), while Mindful Self-Compassion (MSC) interventions are more closely aligned to Neff’s definition.

Australian researcher Madeleine Ferrari and her colleagues published a meta-analysis on self-compassion interventions in 2019 (Ferrari et al, 2019).

Ferrari and colleagues (2019) defined self-compassion as a healthy way of relating to one’s self, and provided a summary of outcomes of randomised controlled trials (RCTs) on self-compassion interventions.

Methods

The Ferrari et al. (2019) meta-analysis included a systematic search of databases, and found 27 eligible RCTs. PRISMA guidelines were followed, and the review included an assessment of study quality.

There were 11 psychosocial outcomes that were assessed in the review. There was no age limit on the participants. The average age range of participants in their review was 36 years of age.

Results

Ferrari et al. (2019) reported that across the 27 included studies, there were:

• Large effect size reductions in eating behaviour (g = 1.76) and rumination (g = 1.37), using Hedge’s g to look at pooled effects across studies
• Moderate reductions in anxiety (g = 0.57), depression (g = 0.66), stress (g = 0.67), self-compassion (g = 0.75), mindfulness (g = 0.62) and self-criticism (g = 0.56).

Results should be considered in the context that publication bias may have been present.

Conclusions

In summary, Ferrari et al.’s (2019) review indicated that self-compassion interventions result in reduced psychological distress, and are promising for improving a range of psychosocial outcomes.

Interestingly, results were stronger for group-based versus individual delivered intervention.

Strengths and limitations

A strength of Ferrari and colleagues (2019) meta-analysis was that there was good methodological rigour in following PRISMA guidelines. There was some evidence of the efficacy of self-compassion interventions on a range of psychological symptoms as well as key measures of self-compassion and self-criticism, which should be expected to be reduced by the intervention.

A key limitation which they noted is that their review did not include any studies that looked at the effects of self-compassion interventions for children or adolescents. The average age range of participants in their review was 36 years of age. The effects of self-compassion interventions have not been specifically assessed in young people in a systematic review, and this is a key limitation of the Ferrari review and gap in knowledge.

Ferrari et al. (2019) also acknowledged their review did not assess for mechanisms of change to determine why self-compassion interventions may work. Future research needs to look at why interventions work, and focus on young people where efficacy has not been looked at in a systematic review, as well as gain the view of young people on self-compassion interventions.

Implications for practice

The results of the Ferrari meta-analysis suggest that self-compassion interventions hold some promise for reducing psychological distress.

Self-compassion for the prevention and treatment of anxiety and depression in young people: our Active Ingredients review

We wanted to understand the impact of increasing self-compassion on anxiety and depression in young people aged 14-24 years.  We searched the scientific literature, consulted with young people with lived experience of anxiety and depression in two stages, and also interviewed researchers in self-compassion.

What did we find from the literature?

We performed a systematic review of self-compassion in young people aged 14-24 years and found 52 studies conducted in 16 countries.  Pooled sample size was 25,104 (59.73% female), with a pooled mean age of 18.06 years. In summary:

• Self-compassion is strongly related to anxiety and depression: the higher their self-compassion, the less likely young people are to feel anxious and depressed.
• Self-compassion buffered the impact of risk factors (e.g., bullying) on anxiety and depression.
• Self-compassion interventions (n = 8) are effective in reducing anxiety and depression in young people, but treatments need to be 4 or more sessions, as brief (2 session) mindfulness training does not work.
• We looked at mechanisms of change, and there was some indication that reductions in self-criticism rather than increases in self-kindness were central.

What did researchers/clinicians say?

• Self-compassion is useful for young people because it helps combat self-criticism.
• A barrier to treatment in young people can be the fear of not achieving if they stop being self-critical.
• Self-compassion involves courage, which consists of turning towards your emotions rather than away from them. It also involves wisdom, such as finding strategies to deal with emotions so you can feel better.

What did young people aged 14-24 say?

• Many young people identified that self-compassion would reduce negative self-talk and self-criticism.
• Young people said self-compassion would be helpful in reducing self-criticism, for example “If you do respect yourself, you’re not gonna think, I’m a failure, or I can’t do this” (Female, 16 years old).
• The term ‘self-compassion’ might have negative connotations, and researchers should be aware of using terms like this and ‘intervention’ because of their connotations.
• Some young people said they would prefer face to face treatments, others online, and treatment should be tailored, taking into account cultural differences, sexuality, and individual experiences, for example: “I don’t just want a cookie cutter, same thing for everybody, I really need something that appeals to me personally.” (Male, 14 years).

What can we conclude?

• Self-compassion is a target for the prevention and treatment of anxiety and depression in young people and should receive further research attention, as results can be considered preliminary to date with 8 studies so far on self-compassion interventions in young people aged 14-24.

Statement of interests  

This work was funded by a Wellcome Trust Mental Health Priority Area ‘Active Ingredients’ commission awarded to SE at Curtin University.  The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

We declare no competing interests.

Links

Primary paper

Ferrari, M., Hunt, C., Harrysunker, A. et al. (2019) Self-Compassion Interventions and Psychosocial Outcomes: a Meta-Analysis of RCTs. Mindfulness 10, 1455–1473 (2019). https://doi.org/10.1007/s12671-019-01134-6 

Other references

Gilbert, P. (2017).  Compassion: definitions and controversies.  In P. Gilbert (Ed.), Compassion: concepts, research and applications (pp.3-15).  London: Routledge.

Neff, K.D. (2003).  Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85-101. doi: 10.1080/15298860309032

Photo credits

• Photo by Ilya Schulte on Unsplash