Are improvements in shame and self‐compassion early in eating disorders treatment associated with better patient outcomes?

Abstract

Compassion-focused therapy (CFT; Gilbert, 2005, 2009) is a transdiagnostic treatment approach focused on building self-compassion and reducing shame. It is based on the theory that feelings of shame contribute to the maintenance of psychopathology, whereas self-compassion contributes to the alleviation of shame and psychopathology. We sought to test this theory in a transdiagnostic sample of eating disorder patients by examining whether larger improvements in shame and self-compassion early in treatment would facilitate faster eating disorder symptom remission over 12 weeks. Participants were 97 patients with an eating disorder admitted to specialized day hospital or inpatient treatment. They completed the Eating Disorder Examination-Questionnaire, Experiences of Shame Scale, and Self-Compassion Scale at intake, and again after weeks 3, 6, 9, and 12. Multilevel modeling revealed that patients who experienced greater decreases in their level of shame in the first 4 weeks of treatment had faster decreases in their eating disorder symptoms over 12 weeks of treatment. In addition, patients who had greater increases in their level of self-compassion early in treatment had faster decreases in their feelings of shame over 12 weeks, even when controlling for their early change in eating disorder symptoms. These results suggest that CFT theory may help to explain the maintenance of eating disorders. Clinically, findings suggest that intervening with shame early in treatment, perhaps by building patients' self-compassion, may promote better eating disorders treatment response.

Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis

“…Baseline self-compassion and fear of self-compassion interacted to predict changes in eating disorder symptoms over time for individuals being treated in specialised eating disorder programs. 33 Specifically, poorer outcomes we observed for patients who were both fearful of, and low in, self-compassion, for example, patients who were low in self-compassion only experienced a poor outcome if they were also fearful of selfcompassion, and vice versa. For individuals with BED, greater concerns about shape and weight were predictive of non-response at the end of treatment among those patients with low interpersonal problems.…”

“…In adults with either AN or BN, a greater reduction in shame (in regards to their body, character, and behavior) during the first 4 weeks of treatment lead to faster rate of improvement in eating disorder symptoms over 12 weeks of treatment (r 5 0.23). 33 In the same study, an early increase in self-compassion led to greater reductions in shame over 12 weeks (r 5 0.15). A novel mediational finding in a recent study suggested that changes in parent self-efficacy during the course of family based treatment predicted adolescents' treatment outcome in a sample of 49 adolescents with AN or BN.…”

A feasibility study of a 2‐week self‐compassionate letter‐writing intervention for nontreatment seeking individuals with typical and atypical anorexia nervosa

“…Importantly, participants' mean estimated self-compassion scores before the intervention were within one standard deviation (SD) of eating disorder patient samples (Kelly et al, 2014) but following the intervention were within one SD of female community samples (Neff, 2003a). The 2-week self-compassionate letter-writing intervention appeared to be acceptable, feasible, and efficacious.…”

“…Given the dangers of the disorder, it is critical to developing alternate interventions that may be more acceptable to these individuals, which could in turn foster greater motivation for specialized treatment. There is now evidence in transdiagnostic samples of individuals with eating disorders that developing self-compassion can lead to a reduction in shame and eating pathology (Gale, Gilbert, Read, & Goss, 2014;Kelly, Carter, & Borairi, 2014). There is now evidence in transdiagnostic samples of individuals with eating disorders that developing self-compassion can lead to a reduction in shame and eating pathology (Gale, Gilbert, Read, & Goss, 2014;Kelly, Carter, & Borairi, 2014).…”

Enhancing flourishing mental health in the general population as a new strategy for the prevention of anxiety and depressive disorders

“…Another series of studies-towards selfcompassion and eating disorders-have shown that (1) a larger improvement of selfcompassion early in treatment was related to a larger decrease of feelings of shame, and that a larger decrease of shame early in treatment was related to a faster decrease of eating disorder symptoms in a transdiagnostic sample (Kelly, Carter, & Borairi, 2014), (2) a compassion-focused self-help intervention for inpatients with a binge eating disorder was more effective in ameliorated eating disorder symptoms, weight concern and selfcompassion compared to a CBT-based self-help intervention (Kelly & Carter, 2015) and (3) a compassion-focused therapy group added to care as usual was more effective than solely care as usual on self-compassion, shame and eating disorder symptoms in a transdiagnostic outpatient sample (Kelly, Wisniewski, Martin-Wagar, & Hoffman, 2016).…”