Investigating the Feasibility of Brief Compassion Focused Therapy in Individuals in Treatment for Opioid Use Disorder

Abstract

Opioid use disorder (OUD) is reaching epidemic proportions worldwide, and is notoriously difficult to treat. Compassion focused therapy (CFT) has emerged as therapeutic tool for treating individuals exhibiting high levels of self-criticism and low self-esteem, both of which are common in OUD. Until now, however, there had been no research investigating this therapy in patients with OUD. Before running a premature clinical trial, it is important to fully assess the feasibility and acceptability of this treatment in this group of individuals. We aimed to assess the feasibility of CFT treatment in individuals with OUD in a short group intervention, which was co-created by the research team, service users and a local drugs service. The intervention involved three 2-hour sessions held over 3 weeks, where participants engaged in compassion-orientated psychoeducation and self-compassionate exercises. Individuals were randomly assigned to either the CFT group (n = 15), the active control (relaxation) group (n = 12) or the waitlist control group (n = 11). Of 103 individuals approached, 45% attended a baseline visit suggesting the treatment was acceptable to this group. A relatively low attrition rate across the 3 groups was found for CFT (21.1%), with no difference in drop-out between the groups. Qualitative analysis of interviews with participants identified a desire for more sessions. Compassion focused therapy was thus feasible and well-tolerated in those with OUD, and a further trial to evaluate any clinical differences may be warranted.

A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion‐focused therapy for chronic illness

“…Although there are studies showing promising efficacy results of ACT in less than four sessions, the average of number of sessions of ACT for CI is approximately six sessions (see Graham et al, 2016). Similarly, although brief CFT interventions seem to be feasible and promising (e.g., Carlyle et al, 2019; Cheli et al, 2020), the average number of sessions of CFT is approximately 10 sessions (see Craig et al, 2020). Future studies should explore differences in efficacy between different lengths and/or intensities of both ACT and CFT.…”

“…In fact, while there is mounting literature on the effects of brief ACT interventions (see Dindo et al, 2017), brief interventions have just recently been explored in CFT. Although results suggest that three to four sessions of CFT are feasible (Carlyle et al, 2019), the few studies that explored its efficacy have not used a control condition (Cheli et al, 2020) or have studied the effects in a short follow‐up period (2 months) (Halamová et al, 2020). Post hoc comparisons suggested that both conditions seemed to be effective in reducing illness‐related shame and uncompassionate self‐responding and in increasing valued action, but seemingly at different paces: while illness‐related shame seemed to decrease only from post‐intervention to follow‐ups in ACT, it seemed to decreased from pre‐ to post‐interventions and was sustained at follow‐ups in CFT.…”

“…Specifically, compassion-that is, a sensitivity to suffering and the motivation to alleviate and prevent it (Gilbert, 2019)-positively impacts immune function and physiological response to stress (e.g., Pace et al, 2009) and increases parasympathetic activity (e.g., Matos et al, 2017) and psychophysiological systems relevant in CI, such as pain modulation (e.g., oxytocin, vasopressin) (e.g., Rockliff et al, 2011). In its face-to-face format, CFT seems to be feasible in reducing psychopathological symptoms in physical conditions, such as acquired brain injury (Ashworth et al, 2015) and persistent pain (Gooding et al, 2020), including through brief (three to foud sessions) (Carlyle et al, 2019) and self-help (Hudson et al, 2019;Sommers-Spijkerman et al, 2018) four assessment moments (pre-intervention, post-intervention, 3-month follow-up and 6-month follow-up). Changes in depressive symptoms, anxiety, illness shame, cognitive fusion, self-compassion and psychological flexibility will be assessed.…”

“…Specifically, compassion—that is, a sensitivity to suffering and the motivation to alleviate and prevent it (Gilbert, 2019)—positively impacts immune function and physiological response to stress (e.g., Pace et al, 2009) and increases parasympathetic activity (e.g., Matos et al, 2017) and psychophysiological systems relevant in CI, such as pain modulation (e.g., oxytocin, vasopressin) (e.g., Rockliff et al, 2011). In its face‐to‐face format, CFT seems to be feasible in reducing psychopathological symptoms in physical conditions, such as acquired brain injury (Ashworth et al, 2015) and persistent pain (Gooding et al, 2020), including through brief (three to foud sessions) (Carlyle et al, 2019) and self‐help (Hudson et al, 2019; Sommers‐Spijkerman et al, 2018) interventions. Although preliminary evidence of the feasibility of delivering CFT online has been presented (for mothers with infants through online resources, Mitchell et al, 2018; for individuals at high risk of psychosis through four video‐call sessions, Cheli et al, 2020; and for general non‐clinical population through practices prompted by email during 13 consecutive days, Halamová et al, 2020), a structured online CFT intervention for CI has not yet been tested.…”

Think again: Adaptive repetitive thought as a transdiagnostic treatment for individuals predisposed to repetitive thinking styles.

“…CFT also appears to be effective in improving psychopathological symptoms transdiagnostically, potentially through reductions in self-criticism and fears of self-compassion (Cuppage, Baird, Gibson, Booth, & Hevey, 2018). More recent studies also point to promising applications for CFT in treating opioid abuse (Carlyle et al, 2019) and addressing mood symptoms in individuals with dementia (Craig, Hiskey, Royan, Poz, & Spector, 2018). In terms of self-compassion, a recent meta-analysis showed that high levels of self-compassion correlated strongly with low levels of psychopathology (MacBeth & Gumley, 2012).…”