Group‐Based Compassion‐Focused Therapy as an Adjunct to Outpatient Treatment for Eating Disorders: A Pilot Randomized Controlled Trial

Abstract

The current study sought to assess the acceptability and feasibility of a compassion-focused therapy (CFT) group as an adjunct to evidence-based outpatient treatment for eating disorders, and to examine its preliminary efficacy relative to treatment as usual (TAU). Twenty-two outpatients with various types of eating disorders were randomly assigned to 12 weeks of TAU (n = 11) or TAU plus weekly CFT groups adapted for an eating disorder population (CFT + TAU; n = 11). Participants in both conditions completed measures of self-compassion, fears of compassion, shame and eating disorder pathology at baseline, week 4, week 8 and week 12. Additionally, participants receiving the CFT group completed measures assessing acceptability and feasibility of the group. Results indicated that the CFT group demonstrated strong acceptability; attendance was high and the group retained over 80% of participants. Participants rated the group positively and indicated they would be very likely to recommend it to peers with similar symptoms. Intention-to-treat analyses revealed that compared to the TAU condition, the CFT + TAU condition yielded greater improvements in self-compassion, fears of self-compassion, fears of receiving compassion, shame and eating disorder pathology over the 12 weeks. Results suggest that group-based CFT, offered in conjunction with evidence-based outpatient TAU for eating disorders, may be an acceptable, feasible and efficacious intervention. Furthermore, eating disorder patients appear to see benefit in, and observe gains from, working on the CFT goals of overcoming fears of compassion, developing more self-compassion and accessing more compassion from others. Copyright © 2016 John Wiley & Sons, Ltd.

Effectiveness of Self-Compassion Related Therapies: a Systematic Review and Meta-analysis

“…Interestingly, the negative subscales (self-judgment, isolation and over-identification) showed a trend for greater improvement than the positive subscales (self-kindness, common humanity and mindfulness); in particular, over-identification (g = 0.72) and isolation (g = 0.63) had the greatest effect sizes. This echoes the results of two other papers included in this review (Kelly and Carter 2015;Kelly et al 2017) that reported larger effects for the negative compared to the positive items. Collectively, these findings speak to the debate around the psychometric properties of the SCS.…”

“…Where an intention-to-treat sample was used, we extracted the full sample size at randomisation, and where per-protocol results were given, we took the sample size of study completers, so that the weighting of studies in the meta-analysis would be proportional to the amount of data contributed. Generally, raw means were extracted, although in two cases (Kelly and Carter 2015;Kelly et al 2017) only estimated means from multilevel modelling were reported.…”

“…In 15 studies, the control condition was waitlist or treatment as usual (TAU). In four of these studies (Huijbers et al 2017;Kelly et al 2017;Key et al 2017;Kingston et al 2015), the control groups provided a high level of comparison with the intervention group, since the participants were under the care of an outpatient clinic with consistent psychotherapy and/or pharmacotherapy. In the other 11 studies, the waitlist/TAU group contained participants with little treatment or no consistent level of treatment.…”

“…In our last subgroup analysis, we grouped studies with a high-level TAU control together with those with an active control group. In practice, this meant re-categorising four studies where all or most control participants received psychological treatment and/or psychotropic medication in their usual care (Huijbers et al 2017;Kelly et al 2017;Key et al 2017;Kingston et al 2015) as having active rather than passive controls. Under this subgrouping, estimates for the three outcomes were as follows: self-compassion, g = 0.35 [0.09, 0.62], p = 0.010; depression, g = 0.16 [− 0.15, 0.47], p = 0.302; and anxiety g = 0.23, [0.00, 0.45], p = 0.049.…”

“…Results for Egger's test were as follows: self-compassion, p = 0.136; anxiety, p = 0.737; depression, p = 0.851. Given that p = 0.1 is taken as the threshold for significance in Egger's Falsafi (2016) Mindfulness-based intervention One active control; one waitlist/TAU control Clinical Hoffart et al (2015) CFT-CFT equivalent Active Clinical Hou et al (2013) Mindfulness-based intervention Active Subclinical Huijbers et al (2015) Mindfulness-based intervention Waitlist/TAU Subclinical Jazaieri et al (2012) Mindfulness-based intervention One active control; one waitlist/TAU control Clinical Kelly and Carter (2015) CFT/CFT equivalent One active control; one waitlist/TAU control Clinical Kelly et al (2017) CFT/CFT equivalent Waitlist/TAU Clinical Key et al (2017) Mindfulness-based intervention Waitlist/TAU Clinical Kingston et al (2015) Mindfulness-based intervention Waitlist/TAU Subclinical Koszycki et al (2016) Mindfulness-based intervention Waitlist/TAU Clinical Kuyken et al (2010) Mindfulness-based intervention Waitlist/TAU Subclinical Mann et al (2016) Mindfulness-based intervention Waitlist/TAU Subclinical Shahar et al (2015) CFT/CFT equivalent Waitlist/TAU Subclinical Van Dam et al (2014) Mindfulness-based intervention Waitlist/TAU Subclinical Yadavaia et al (2014) ACT Waitlist/TAU Subclinical test, we took the borderline result for self-compassion as reason for investigating the sensitivity of the self-compassion effects to publication bias by running the trim-and-fill procedure on the residuals for the moderated model for self-compassion. This indicated that 3 studies were 'missing' from the left of the plot and that adding these would adjust the summary effect slightly, β = 0.08.…”