Acceptability, feasibility and preliminary efficacy of a compassion-based cognitive behavioural intervention for low self-esteem in sexual minority young adults.

Low self-esteem can impair daily functioning and is a risk or maintenance factor for several mental health problems. Sexual minority young adults, for example, those identifying as lesbian, gay or bisexual, on average have lower self-esteem than their heterosexual peers. Compassion-based interventions for low self-esteem might be especially beneficial for sexual minority young adults, whose higher levels of shame and self-criticism are likely to be contributing to maintenance of their low self-esteem. This study explored the acceptability, feasibility and preliminary efficacy of a new compassion-based cognitive behavioural intervention for low self-esteem tailored to sexual minority young adults. Participants were a community sample of 24 sexual minority young adults aged 16-24 experiencing clinically significant low self-esteem. An uncontrolled pre-/post-design was used with qualitative feedback and quantitative outcomes. Self-report standardised measures were completed at baseline, pre-intervention, intervention mid-point, post-intervention and 2-month follow up. Preliminary efficacy was examined through post-intervention changes in self-esteem, functioning, anxiety and depression. Potential mechanisms of change were examined through changes in self-compassion, self-criticism and unhelpful coping responses to minority stress. Results showed good acceptability and feasibility and preliminary evidence of intervention efficacy for improving self-esteem, functioning, depression and anxiety. There was evidence for improvement in self-compassion and reduction in self-criticism, and these constructs could be investigated in future studies as treatment mediators. Randomised controlled studies are needed to further examine efficacy of the intervention.

Comparison of clinical and neuropathological diagnoses of neurodegenerative diseases in two centres from the Brains for Dementia Research (BDR) cohort.

Early detection and accurate diagnosis of neurodegenerative disorders may provide better epidemiological data, closer monitoring of disease progression and enable more specialised intervention. We analysed the clinical records and pathology of brain donations from 180 patients from two Brains for Dementia Research cohorts to determine the agreement between in-life clinical diagnosis and post-mortem pathological results. Clinical diagnosis was extracted from medical records and cases assigned into broad clinical groups; control, Alzheimer's disease (AD), vascular dementia (CVD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD) and combined diseases. Pathology was assessed blindly, and cases categorised into; control, intermediate AD, severe AD, CVD, AD and CVD combined, DLB, AD and DLB combined and frontotemporal lobar degeneration (FTLD), according to the major contributing pathologies. In more than a third of cases clinical diagnosis was different from final neuropathological diagnosis. The majority of AD, DLB and control clinical groups matched the pathological diagnosis; however, thirty-five percent of clinical AD cases showed additional prominent CVD or DLB pathology which had not been diagnosed clinically and twenty-five percent of clinical control cases were found to have intermediate Tau pathology (modified Braak stage III-IV) or CVD. CVD and AD + CVD clinical groups showed an average of only thirty-two percent pathological correlation, the majority actually having no CVD, and fifty-three percent of pathologically identified FTLD cases had been incorrectly clinically diagnosed. Our results underlie the importance of neuropathological confirmation of clinical diagnosis. The relatively low accuracy of clinical diagnosis demonstrates the need for standardised and validated diagnostic assessment procedures.

A cognitive behavioural intervention for low self-esteem in young people who have experienced stigma, prejudice, or discrimination: An uncontrolled acceptability and feasibility study.

OBJECTIVES: Stigma has been found to be associated with lower self-esteem, which increases the risk of difficulties across life domains including vulnerability to mental health problems. There are no previous studies of interventions for people experiencing low self-esteem in the context of different stigmatized characteristics. This study evaluated feasibility, acceptability, and preliminary outcomes of an intervention targeting low self-esteem in stigmatized people aged 16-24 years. DESIGN: An uncontrolled study with repeated measures. METHOD: People with a range of stigmatized characteristics, who had low self-esteem and associated impaired daily functioning, were recruited from the general population. The individual six-session cognitive behavioural intervention had modules chosen according to participants' formulations. The CBT included compassion-focussed therapy methods and was informed by stigma research. Feasibility was assessed in relation to recruitment, retention, and protocol adherence. Acceptability was assessed through participant feedback. Questionnaires assessing self-esteem, functioning impairments, depression, anxiety, self-criticism, self-compassion, and responses to prejudice and discrimination were administered at baseline, pre-, mid-, post-intervention, and two-month follow-up. RESULTS: Forty-four people completed screening; 73% were eligible. Of these, 78% consented and 69% (N = 22) started the intervention. Eighteen (82%) participants completed, and four dropped out. Follow-up measures were completed by all treatment completers. Treatment completers reported the intervention was useful, improved their self-esteem and coping, and would recommend it. Ratings of usefulness and frequency of use of intervention components were high at post-treatment and follow-up. CONCLUSIONS: The intervention was feasible and highly acceptable to treatment completers. This suggests the intervention warrants investigation in a randomized-controlled trial. PRACTITIONER POINTS: Young people with low self-esteem whom have been negatively affected by stigma may wish to access support and be willing to engage in psychological interventions. Cognitive behavioural therapy may be helpful for young people with low self-esteem who have experienced stigma, prejudice, or discrimination. Cognitive behavioural techniques such as self-compassionate thought records and behavioural experiments were considered acceptable and helpful by young people whose self-esteem has been affected by stigma. Addressing responses to stigma in therapy, such as rumination, avoidance, and perfectionism, appears to be feasible and acceptable.