Thesis (Ph.D.)--Baylor University, 2006. / Includes bibliographical references (p. 189-200).

“Non-affective” psychotic disorders are in fact associated with a high rate of emotional disorders. A number of attachment-based models of impairments in emotion regulation and mentalization in psychosis have been put forward. The present thesis aimed to explore psychobiological markers of emotion regulation in order to develop and pilot a novel psychological intervention. The portfolio consists of six peer-reviewed published articles. Four studies were conducted involving 167 psychosis patients and 66 community controls resulting in four original articles, a theory paper and a metaanalysis. Paper 1- 3 explored emotion regulation using different methods (self-report, hormonal, attachment-based narrative). Paper 4 lays out a compassion-focused model for promoting emotional recovery from psychosis. Paper 5 presents data from a feasibility trial of Group Compassion Focused Therapy. Paper 6 presents an updated attachment- and compassion-focused model of emotion regulation and mentalization in the context of a meta-analysis of effects of intranasal oxytocin on symptoms and social cognition in psychosis. Childhood trauma – especially emotional abuse - was strongly associated with dissociation in psychosis patients compared to non-psychotic community controls – most strongly in chronic patients (Paper 1). Psychosis patients with childhood trauma showed significantly lower basal cortisol levels indicative of impaired stress regulation than those without childhood trauma (Paper 2). Impaired emotion regulation operationalised as attachment-based mentalisation was associated with problematic adolescent development and emotional and interpersonal adaptation to a first episode of psychosis in qualitative interviews. A novel attachment-based model for improving emotion regulation in psychosis by way of strengthening the caregiving/ receiving and affiliation system through Compassion Focused Therapy (CFT) was put forward (Paper 4). A feasibility trial showed that group CFT was safe, well-accepted and associated with greater clinical improvement and greater increases in compassion compared to treatment as usual. Increases in compassion in CFT were associated with reductions in shame, perceived social marginalisation, fear or relapse and depression (Paper 5). A metaanalysis of oxytocin administration as a biological way of strengthening the care-giving/receiving and affiliation system in psychosis was conducted yielding medium effects despite significant heterogeneity (Paper 6). Findings replicated the strong association between childhood trauma and dissociation in psychosis patients relative to controls highlighting the importance of emotional abuse and suggesting underlying difficulties with regulating distress related to early interpersonal trauma. Lower basal cortisol in patients with childhood trauma appeared to support the presence of emotion regulation difficulties due to early interpersonal trauma on a physiological level. Qualitative findings helped to generate hypotheses about inhibitors and facilitators of recovery and targets for intervention including the moderating role of mentalization. A novel attachment- and compassion-focused model was outlined and successfully piloted yielding important signals of change such as increases in compassion, which appear to reduce depression and social marginalisation in particular. This model helped account for inconsistencies in oxytocin studies of psychosis. In summary, findings extend existing research on emotion regulation in psychosis by supporting links to early interpersonal trauma and attachment and offer a promising novel attachment-and compassion-focused psychological intervention and a comprehensive biopsychosocial framework for further improving emotion regulation and mentalization in people with psychosis.

Background: Compassion Focused Therapy aims to reduce shame through the development of compassion towards the self (Gilbert & Proctor, 2006). In a recent meta-analysis, MacBeth & Gumley (2012), identified self-compassion as a good predictor of mental wellbeing in adult populations. In addition, Werner et al (2012) provided preliminary evidence that difficulties with self-compassion may contribute to the development and maintenance of social anxiety. Despite wide recognition that social anxiety arises in adolescence and can be a pre-cursor to the development of other psychological disorders, the relationship between self-compassion and social anxiety is yet to be explored in younger populations. Objective: The following portfolio aims to add to the current literature by firstly, completing a systematic review to examine whether the association between shame and social anxiety is supported by empirical research and secondly, examining the relationship between self-compassion and social anxiety in an adolescent community sample. The role of recognised cognitive factors of social anxiety i.e. fear of negative evaluation, self-focused attention and cognitive avoidance in mediating the relationship between self-compassion and social anxiety and the role of possible confounders i.e. depression and generalised anxiety were also examined. Method: A systematic review of studies that assess the association between shame and social anxiety symptomology was undertaken. The empirical study comprised a cross-sectional design in which 414 community based adolescents, aged 14-18, were recruited from 4 local schools to complete 7 validated psychometric questionnaires: Self-compassion Scale (Neff, 2003), The Social Phobia Inventory (Connor et al, 2000), the Social Anxiety Scale for Adolescents (LaGreca, 1998), The Cognitive Avoidance Questionnaire (Gosselin et al, 2002), the Self Consciousness Scales (Fenigstein et al, 1975), Screen for Child Anxiety Related Emotional Disorders (Birmaher et al, 1995) and the Short Mood and Feeling Questionnaire (Angold et al, 1995). Systematic Review Results: Twenty one studies met the inclusion criteria of the systematic review and demonstrated a positive association between shame and social anxiety symptomology. Methodological factors, depression and gender were found to impact on the power of this association. Empirical Project Results: Self-compassion was found to be inversely related to social anxiety, r=-.551, p < .0001, 95%CI[-.62, .48], with both fear of negative evaluation and cognitive avoidance, but not self-focused attention, partially mediating this relationship. Self-compassion was found to be a unique predict of social anxiety, explaining additional variance when depression and generalised anxiety were controlled for. Conclusions: The above studies extend existing literature on the relationship between shame, social anxiety and self-compassion. In particular the use of an adolescent sample provides evidence of the usability and applicability of self-compassion concepts with younger populations. Similarly, the above studies expand our understanding of the concepts underlying social anxiety, specifically in adolescents, for whom social anxiety is extremely prevalent. It is hoped that the above research may highlight associations in need of further investigation, in particular with clinical samples, and inform the development of compassion focused adaptations or interventions for this population.

Background: The societys requirements for nurses working in care are to achieve good qualitative, safe care for patients that experiencing several trauma and suffering. Todays medical care with high patient flow and pace, as well as savings and low nursing staffing. Reported to be contributing factors to nurses suffering from compassion fatigue. Problem:The combination of this and the inadequate guidelines or support for being able to handle these requirements as a nurse, this contributing factors to nurses developing compassion fatigue Purpose: The purpose of the thesis work is to highlight the nurses experience of compassion fatigue. Method: A qualitative literature study with descriptive synthesis, twelve articles has been analyzed according to Evans (2002). Results: To create a balance between working life and priva life, having knowledge and being read as well as taking care of yourself is considered essential to avoid compassion fatigue. A support from management and colleagues was considered important to counteract compassion fatigue. Conclusion: nurses who experience stress or compassion fatigue as well as lacking tools or knowledge about what counteracts compassion fatigue can have difficulty emotionally engaging in caring. Which contributes to stress and even poorer quality of care.

Background: Post-traumatic stress and exposure to early traumatic events are often characterised by negative self-cognitions and experiences of shame, guilt or blame. These symptoms are theoretically linked to the concept of self-compassion which is an important factor in affect regulation, and is predictive of mental wellbeing and psychological distress. Interventions aimed at increasing acceptance, non-judgement and self-compassion such as mindfulness may be useful in the treatment of post-traumatic stress symptoms. Methods: The first part of this portfolio presents a systematic review which aimed to collate and evaluate the existing research for the use of mindfulness based interventions to treat post-traumatic stress symptoms. The search process involved a systematic search of relevant research databases, hand search of relevant journals, and relevant authors were contacted. The second part of this portfolio presents a quantitative research study which explored the relationship between the experience of childhood trauma and self-compassion; and whether self-compassion was predictive of post-traumatic stress and growth in an adult clinical sample. Data were collected through postal survey and analysed using correlation and hierarchical regression analysis. Systematic Review Results: The systematic review resulted in 12 studies which met eligibility criteria, the majority of studies indicated positive outcomes with improvements in post-traumatic stress symptoms, particularly in reducing avoidance. Many of these studies lacked methodological rigour and further studies with more robust research design are required. Research Study Results: The quantitative study showed that greater experience of childhood emotional abuse, neglect, punishment and sexual abuse were significantly correlated with lower self-compassion in adulthood. Hierarchical regression showed that self-compassion was predictive of total post-traumatic stress symptoms, post-traumatic avoidance and intrusion when age, gender, exposure to traumatic events and childhood trauma were controlled. The experience of post-traumatic growth showed no significant relationship with self-compassion. Conclusions: Studies indicate that mindfulness interventions show promise for the treatment of PTSD symptoms, although further research with more robust methodology is needed. Greater experience of childhood abuse is related to lower self-compassion in adulthood and lower self-compassion is predictive of higher PTSD avoidance and intrusion symptoms. This suggests that future research investigating self-compassion interventions may be beneficial in treating PTSD.

People who are marginalized based on their sexual orientation or gender identity face heightened risk of negative health and psychological outcomes compared to more privileged populations (Meyer, 1995; Hughes, Szalacha, & McNair, 2010). Previous researchers have suggested that positive coping strategies may be beneficial in reducing the high risks of negative outcomes, such as depression, associated with Lesbian, Gay, Bisexual, Transgender (LGBT) minority stress (Branscombe, Schmitt, & Harvey, 1999, Kertzner, 2001). Moreover, certain sociocultural factors, such as gender role stress (Eisler, 1995; Eisler & Blalock, 1991; Eisler & Skidmore, 1987; Gillespie & Eisler, 1992), may influence LGBTQ+ individuals’ experience of minority stress in unique ways, but gaps in this area of the literature remain. The purpose of this study will be to examine the relationships between gender role stress, LGBTQ+ minority stress, self-compassion, and depression in a sample of LGBTQ+ adults. I will conduct regression analyses and mediation analyses to test the following main hypotheses: (a) Gender role stress will be significantly associated with LGBTQ+ minority stress, (b) LGBTQ+ minority stress will be associated with higher levels of depression symptoms, and (c) self-compassion will fully mediate the relationship between LGBT minority stress and depression.

There is a growing body of interest in wellbeing across political, educational and social bodies in the UK. The thinking behind this is for human as well as economic reasons, to help people make more informed choices in their lives. There are suggestions to measure wellbeing more often and use that data to help government improve policies and enable companies and individuals to live more productive lives for example by considering being more altruistic to improve personal and family wellbeing during a time of financial austerity (O’Donnell, 2014: 9). There is a fundamental problem however in that there is no common understanding of what wellbeing is across different bodies and agencies, including education, mainly because the term is subjectively defined. Yet teachers are required to report to parents on children’s wellbeing and also safeguard their wellbeing, Teachers’ Standards 2012 (DfE, 2013), but there are no common measures of wellbeing in use nationally. The purpose of this case study is to try to reduce ambiguity about wellbeing issues through identifying gaps in knowledge in the literature about what wellbeing in schools is. The investigation uses qualitative methods and as an inside researcher, to aid authenticity of data, a two-tier approach to gathering data is taken within a constructivist paradigm. The approach enables three voices to be heard, that of pupils and parents (data set one) and then teachers (data set two). The first pupil theme revealed that pupils had a strong sense of connectedness to the school, friends and teachers while the second theme showed approaches to learning that had resonated with pupils. The theme to emerge from parents was a loving community where they felt enabled to entrust their children to teachers who were passionate about their role and evidenced compassion in their working with children. Themes from teachers revealed responsive and enthused professionals who, through collaboration in action learning sets, influenced transition arrangements and ways they felt they could be further empowered in their role. Wellbeing deriving from empowerment through interconnected relationships within and across the three groups leads to an analysis of the community as one that accepts difference. The significance of this for wellbeing in education and policy is discussed.

Purpose: This study assessed whether a mindfulness-based intervention (MBI) adapted for social anxiety disorder (SAD) led to increases in self-compassion and trait mindfulness, and whether these increases mediated change in SAD symptom severity. Methods: Participants were randomly assigned to a 12-week MBI adapted for SAD (MBI-SAD, n = 21) or a wait-list control (WLC, n = 18). The MBI-SAD included aspects of the mindfulness-based stress reduction program, as well as explicit training in self-compassion and “mindful exposure”. Participants were assessed at baseline and weeks 6 and 12. Results: The MBI-SAD resulted in higher self-compassion and trait mindfulness and lower levels of social anxiety, compared to the WLC. Mediation analyses revealed that self-compassion and aspects of trait mindfulness mediated clinical response. Implications: Results suggest that self-compassion and aspects of trait mindfulness are possible mechanisms of change for the MBI-SAD. Results and their implications are discussed.

Registered dietitians who treat patients with eating disorders may be at risk for developing compassion fatigue due to exposure to patients' chronic complications. Dietetic courses and programs do not comprise coping and resilience training, therefore, dietitians who work with these patients may need additional education. The purpose of this basic qualitative research study was to investigate the perceptions of practicing registered dietitians and dietetic educators on the risk of compassion fatigue, investigate ways to manage and prevent the development of compassion fatigue, and explore the possible need for professional education. Knowles's theory of andragogy provided the conceptual framework as perceptions of educational experiences were explored. Face-to-face semistructured interviews were conducted with 4 registered dietitians whoA treat patients with eating disorders and 4 registered dietitians who are dietetic educators. Data were analyzed using NVivo 12 and a 6-step thematic analysis technique. The 6 themes that emerged from the data included repeated exposure to pain and suffering caused emotional exhaustion and numbness; the risk of compassion fatigue is highest when dietitians are underprepared for the repeated exposure to trauma, pain, and suffering; seeking support is possibly a way to manage and prevent compassion fatigue; setting boundaries, separation of self from work, and self-care are necessary; and education and awareness about compassion fatigue and self-care is needed. An in-person 3-day workshop on preventing and managing compassion fatigue was developed, which can positively impact social change by improving patient care and contributing to the overall wellness in registered dietitians who work with patients with eating disorders.

Background: Motivational Interviewing (MI) is an accepting and compassionate collaborative counselling style that has been linked with various desirable client outcomes. However, its association with self-compassion (SC), an important psychological resource is unknown. One context in which this relationship can be studied is in Physical Activity Counselling (PAC), which is an MI-based intervention that has been found to enhance motivation towards physical activity (PA) and PA behaviour, as well as reduce depressive symptoms. However, no hypothesized link has ever been made between MI and SC and no research has been done on the impact of MI-based PAC onto SC or has investigated SC’s relationship with PA within PAC. Purpose: Article 1: To explore the link between MI and SC. Article 2: To test this proposed association by investigating the impact of a MI-based intervention, specifically through PAC, over time on (1) self-compassion and its subcomponents, and (2) PA and its intensities. A third and fourth purpose were to (3) examine whether any improvements in SC or PA variables were continued at 1-month follow-up and lastly, (4) study the relationships between SC and PA variables over time in university students and employees receiving PAC. Methods: Article 1: This article was a commentary paper that rationalized the hypothesized link between MI and SC. Article 2: This article reports results from a study which used a repeated-measures experimental study design, whereby forty university students and employees filled out online validated self-report questionnaires assessing SC and PA before (baseline), immediately after (endpoint), and 1-month after (follow-up) receiving individualized PAC sessions. Participants reached out to PAC mostly on their own or were referred by other programs on campus. Fidelity checks showed that PAC counsellors were accepting and compassionate. Results: Article 1: A hypothesized link was made between MI and SC, such that the accepting and compassionate spirit of MI, as well as certain content-based techniques used within could help to foster a self-compassionate mindset within the receivers of MI. Article 2: Paired-samples t-tests and multivariate analysis of variance tests revealed that there were significant moderate-to-large increases in total SC, self-kindness, and total, moderate, and strenuous PA from baseline to endpoint. There was also a significant large effect for decreases in self-judgement and isolation from baseline to endpoint. All changes appeared to be continued at 1-month follow-up. Lastly, results revealed that common humanity at baseline positively influenced moderate PA at endpoint. Conclusion: This provides a strong case for the link between MI and SC and provides preliminary evidence to support the positive impact of MI, specifically through PAC, onto SC and PA variables, as well as their relationship over time. Future research is recommended in order to ascertain these findings and practitioners are encouraged to show high acceptance and compassion while assisting individuals with PA behaviour change.