Stages of lipoedema: experiences of physical and mental health and health care.

PURPOSE: Lipoedema is a progressive adipose (fat) disorder, and little is known about its psychological effect. This study aimed to determine the experiences of physical and mental health and health care across stages of lipoedema. METHODS: Cross-sectional, secondary data from an anonymous survey (conducted 2014-2015) in Dutch and English in those with self-reported lipoedema were used (N = 1,362, Mdnage = 41-50 years old, 80.2% diagnosed). χ2 analyses of categorical data assessed lipoedema stage groups 'Stage 1-2' (N = 423), 'Stages 3-4' (N = 474) and 'Stage Unknown' (N = 406) experiences of health (physical and psychological), and health care. RESULTS: Compared to 'Stage 1-2', 'Stage 3-4' reported more loss of mobility (p = < .001), pain (p = < .001), fatigue (p = .002), problems at work (p = < .001) and were seeking treatment to improve physical functioning (p = < .001) more frequently. 'Stage 3-4' were more likely to report their GP did not have knowledge of lipoedema, did not take them seriously, gave them diet and lifestyle advice, dismissed lipoedema, and treated them 'badly' due to overweight/lipoedema compared to 'Stage 1-2' (p = < .001). 'Stage 3-4' were more likely to report depression (p = < .001), emotional lability (p = .033) eating disorders (p = .018) and feeling lonelier, more fearful, and stayed at home more (p = < .001) and less likely to have visited a psychologist (p = < .001) compared to 'Stage 1-2'. CONCLUSIONS: A divergent pattern of physical and psychological experiences between lipoedema stages reflects physical symptom differences and differences in psychological symptoms and health care experiences. These findings increase the understanding of lipoedema symptoms to inform psychological supports for women with lipoedema in navigating chronic health care management.

Compassionate mind training for ex-service personnel with PTSD and their partners.

Posttraumatic stress disorder (PTSD) is a significant issue for a substantial proportion of Australian ex-service personnel. In addition to the functional impact on individuals, PTSD can have a significant impact on intimate partner relationships. Research has demonstrated that practicing compassion and self-compassion may be an important component of psychological therapy for survivors of trauma, while also demonstrating benefits to intimate relationships. This pilot study aimed to investigate the utility of a Compassionate Mind Training intervention for ex-service personnel with PTSD and their partners. An uncontrolled, within-subjects, longitudinal design was utilized with assessment at pre-intervention, post-intervention and 3-month follow-up. Twenty-four participants attended 12 biweekly group sessions. Self-report measures of compassion, quality of life and psychological symptoms were administered at each time point. Findings demonstrated a significant reduction in fears of compassion and PTSD symptoms for ex-service personnel at 3-month follow-up and a reduction in depressive symptoms and increase in quality-of-life and social safeness at post-intervention. Additionally, significant reductions in anxiety, stress, external shame and self-criticism at 3-month follow-up were found, and couples reported significant increases in relationship satisfaction. Findings from this pilot study demonstrate promising outcomes, warranting further investigation in a larger randomized controlled trial of Compassionate Mind Training for ex-service personnel and their partners.

Compassion-focused therapy for body weight shame: A mixed methods pilot trial.

Individuals with bigger bodies (body mass index greater than 30) often experience body weight shame and are at increased risk for mental health vulnerabilities such as depression and anxiety. To date, there have been no studies specifically designed and pilot tested to help with body weight shame for individuals with bigger bodies that do not have a diagnosed clinical condition. The aim of current study is to investigate the initial feasibility of compassion-focused therapy (CFT) as a 12-session group intervention for the reduction in body weight shame for individuals with bigger bodies. The study used a mixed method repeated measure design, with both quantitative and qualitative measures, to assess the initial feasibility of the CFT group-based intervention. Participants (N = 5) attended a 12-session/2-h group CFT programme aimed to directly target body weight shame by cultivating compassion. Measurements were conducted at three time points (pre-, post- and 3-month follow-up intervention). Results indicated that CFT had a positive impact on reducing body weight shame, increasing compassion and improving health-engaging behaviours. Qualitative feedback indicated the importance of the group dynamics to help with the de-shaming of body appearance for individuals. Results from this feasibility trial are promising, and future research using randomized controlled trial methodologies should be conducted to evaluate the effectiveness of CFT as a treatment option for body weight shame for individuals with bigger bodies.

Surviving or thriving: quality assurance mechanisms to promote innovation in the development of evidence-based parenting interventions.

Parenting interventions have the potential to make a significant impact to the prevention and treatment of major social and mental health problems of children. However, parenting interventions fail to do so because program developers pay insufficient attention to the broader ecological context that influences the adoption and implementation of evidence-based interventions. This context includes the professional and scientific community, end users, consumers, and broader sociopolitical environment within which parenting services are delivered. This paper presents an iterative stage model of quality assurance steps to guide ongoing research and development particularly those related to program innovations including theory building, intervention development, pilot testing, efficacy and effectiveness trials, program refinement, dissemination, and planning for implementation and political advocacy. The key challenges associated with each phase of the research and development process are identified. Stronger consumer participation throughout the entire process from initial program design to wider community dissemination is an important, but an often ignored part of the process. Specific quality assurance mechanisms are discussed that increase accountability, professional, and consumer confidence in an intervention and the evidence supporting its efficacy.

The acceptability of parenting strategies for grandparents providing care to their grandchildren.

Despite the evidence supporting parenting programmes as a pathway to reduce and prevent childhood emotional and behavioural problems, these programmes still have low rates of uptake by families in the community. One way of increasing the participation rates of families in parenting programmes is to adopt a consumer's perspective to programme design and development. This study sought to examine whether grandparents providing regular care to their grandchildren viewed the strategies advocated in a parenting programme developed specifically for them as being acceptable and useful, and whether there were barriers to programme use. Forty-five grandparents, with an average age of 61.4 years (SD = 5.0), participated in the study. Grandparents provided between 11 and 20 h of care per week to their grandchildren, who were on average 4.5 years old (SD = 2.4), with the majority being boys (60%). Results revealed that grandparents found the strategies promoted in the parenting programme highly acceptable and useful and were likely to use the strategies. Barriers to using specific strategies included time demands and belief that a specific strategy would not work. The implications of these findings are discussed within the context of consumer involvement in programme design and development.

Social rank and compassion: How insecure striving, social safeness and fears of compassion mediate the relationship between masculinity, depression and anxiety.

OBJECTIVE: Traditional masculinity norms displayed by men attempt to signal a dominance or 'toughness' to others; however, traditional masculine norms are associated with a range of mental health difficulties, including depression and anxiety. Based on social rank theory, we tested the mediating role of insecure striving, social safeness and fears of compassion on the relationship between masculinity, anxiety and depression. We also examined whether compassionate goals were negatively correlated with masculine norm adherence. DESIGN: We used a cross-sectional survey design recruiting 844 men, aged 18-60 years (M = 34.0, SD = 14.4). RESULTS: Our results replicated previous findings with masculine norms significantly associated with depression and anxiety. Extending on previous work, we found insecure striving, social safeness and fears of compassion fully mediated these relationships for anxiety and partially for depression. This relationship was strongest for the masculinity subtypes of self-reliance and emotional control. Compassionate goals were negatively associated with masculine norm adherence. CONCLUSIONS: Social rank theory offers a helpful explanatory framework to understand the links between traditional masculinity and mental health, highlighting the importance of social safeness and insecure striving for men.

Evaluating multidimensional facets of the maternal experience after preterm birth.

OBJECTIVE: Describe self-relating (self-criticism, self-compassion) and parenting competence (satisfaction, self-efficacy) in mothers of children born preterm, and their associations with child characteristics, maternal sociodemographics at childbirth, and maternal concurrent well-being. STUDY DESIGN: The sample comprised 1926 biological mothers of 3- to18-year-old children born preterm with self-ratings on the standardized Forms of Self-Criticising/Attacking & Self-Reassuring Scale, Self-Compassion Scale, and Parenting Sense of Competence Scale. RESULTS: Mothers of children in early childhood reported significantly (p < 0.05) lower self-compassion than in middle childhood and adolescence. They also reported significantly lower parenting satisfaction than mothers of adolescents and higher self-efficacy than their middle childhood counterparts. Maternal psychosocial well-being was most strongly associated with self-compassion, parenting satisfaction, and self-efficacy after accounting for maternal psychopathology, child gestation, and child age. CONCLUSION: Longer-term associations of preterm birth with maternal self-relating and parenting competence emphasize broadening the scope of neonatal follow-up services, extending beyond child neurodevelopmental surveillance and postpartum psychopathology screening.

A systematic review of compassion-based interventions for individuals struggling with body weight shame.

OBJECTIVE: This systematic review investigated compassion-based interventions and the extent to which they can assist with addressing body weight shame. DESIGN: The systematic review was pre-registered and conducted according to PRISMA guidelines. Seven electronic databases (PsycNET, Pubmed, Web of science, CINAHL, Scopus, ProQuest, Social Science Database) were searched. The methodological quality of studies was also assessed. MAIN OUTCOME MEASURES: Main outcomes were body weight shame, and compassion. Secondary outcomes assessed were mental health, eating attitudes and behaviours, physical exercise and Body Mass Index and weight. RESULTS: 25 studies (23 papers) met inclusion criteria and results indicated promise for compassion-based interventions for body weight shame, compassion, and health related behaviour. Mixed results were found for BMI and weight. The studies varied considerably in terms of populations targeted, the duration of interventions, and intervention delivery.Conclusion: Overall, compassion-based interventions were found to reduce body weight shame and improve levels of compassion. However, the impact of compassion-based interventions on BMI and weight is less promising. Recommendations for future research are provided.

A brief compassion focused therapy intervention can help self-critical parents and their children: A randomised controlled trial.

BACKGROUND: Parents can be highly self-critical of their own parenting, which can negatively impact parenting style and child outcomes. AIMS: The aim of this randomised controlled trial (RCT) was to examine the efficacy of a brief 2-hour Compassion Focused Therapy intervention (CFT) for parents to determine if it can reduce self-criticism, improve parenting and improve child social, emotional and behavioural outcomes. MATERIALS & METHODS: In total, 102 parents (87 mothers) were randomised to either a CFT intervention (n = 48) or waitlist control group (n = 54). Participants were measured at pre-, 2-week post-intervention and the CFT group again at 3-month follow-up. RESULTS: At 2-week post-intervention parents in the CFT group compared to waitlist control had significantly reduced levels of self-criticism, significant reductions in child emotional and peer problems, but no changes in parental style. At 3-month follow-up, these outcomes improved, with self-criticism further decreasing, parental hostility and verbosity decreasing, as well as a range of childhood improvements. CONCLUSION: The results from this first RCT evaluation of a brief 2-hour CFT intervention for parents show promise for not only improving how parents relate to themselves with self-criticism and self-reassurance, but also for improving parenting styles and child outcomes.

Compassion-Focused Therapy to Reduce Body Weight Shame for Individuals With Obesity: A Randomized Controlled Trial.

Adults living in larger bodies (Body Mass Index > 30) often experience body weight shame, are highly self-critical, and are at increased risk for anxiety and depression. To date, there have been no RCTs examining the efficacy of Compassion-Focused Therapy (CFT) to help those experiencing body weight shame. The aim of the current study was to investigate the efficacy of CFT as a 12-session group intervention to reduce body weight shame for individuals living in larger bodies. The study used an RCT design with participants randomized to the CFT (n = 28) or waitlist control (n = 27) condition. Participants in both groups were assessed at pre- and postintervention, with the CFT group alone assessed at 3- and 6-month follow-up intervention. Both self-report and a physiological measure of parasympathetic nervous system activity were used (i.e., heart rate variability). Results indicated that CFT had a significant positive impact at postintervention compared to the control group for body weight shame (internal and external), increasing self-compassion, reducing fears of compassion (self, other, and receiving), reducing self-criticism, and reducing external shame. Although there were no significant group effects at postintervention on depression and anxiety, 66% of participants had clinical improvement on depression in the CFT group compared to 8% in the control group at postintervention. CFT did not shift baseline heart rate variability at postintervention. The evidence from this RCT supports CFT as an efficacious intervention to reduce body weight shame for individuals with obesity.

Risk profiles of the preterm behavioral phenotype in children aged 3 to 18 years.

Objective: Characterize the Preterm Behavioral Phenotype in children born preterm by identifying distinct profiles based on patterns of symptomatology or severity of the risk for attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety, and determine their associations with child sex, gestational age, and chronological age. Methods: Sample comprised 2,406 children born preterm aged 3-18 years with primary caregiver behavioral ratings on the standardized Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale, Social Responsiveness Scale, and Preschool Anxiety Scale or Screen for Child Anxiety and Related Emotional Disorders. Results: Statistical fit indices of latent profile analysis supported a 3-profile model as optimal. Using this model, 75% of children born preterm were identified as having low expression, 20% moderate expression, and 5% high expression profiles of the Preterm Behavioral Phenotype described as co-occurring symptomatology of attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety. Male children were more likely than females to be categorized in the moderate expression [Relative Risk Ratio (RRR) = 1.29, 95% CI = 1.05-1.59], and high expression profiles (RRR = 1.77, 95% CI = 1.17-2.66). Children born extremely preterm were more likely than those born moderate/late preterm to be categorized in the moderate expression (RRR = 1.68, 95% CI = 1.30-2.19) and high expression profiles (RRR = 2.06, 95% CI = 1.31-3.25). Finally, those in the school-age (RRR = 1.68, 95% CI = 1.32-2.14; RRR = 1.95, 95% CI = 1.21-3.13), early adolescence (RRR = 1.85, 95% CI = 1.38-2.48; RRR = 2.61, 95% CI = 1.53-4.44) and late adolescence (RRR = 2.09, 95% CI = 1.38-3.19; RRR = 2.28, 95% CI = 1.02-5.08) periods were more likely than those in the preschool period to be categorized in the moderate and high expression profiles, respectively. Conclusion: A quarter of children born preterm were at elevated risk for manifesting symptomatology across all three domains of the Preterm Behavioral Phenotype. Findings emphasize accounting for symptom co-occurrence of this phenotype in neurodevelopmental follow-up and psychosocial interventions to optimize child outcomes.

Testing the bounds of compassion in young children.

Extensive research shows that, under the right circumstances, children are highly prosocial. Extending an already published paradigm, we aimed here to determine what factors might facilitate and inhibit compassionate behaviour. Across five experiments (N = 285), we provide new insight into the bounds of 4- to 5-year-old children's compassionate behaviour. In the first three experiments, we varied cost of compassion by changing the reward (Study 1), using explicit instructions (Study 2) and ownership (Study 3). In the final two experiments, we varied the target of the compassionate behaviour, examining adults compared with puppet targets (Study 4), and whether the target was an in-group member (Study 5). We found strong evidence that cost reduces compassionate responding. By contrast, the recipient of compassion did not appear to influence responding: children were equally likely to help a human adult and a puppet, and an in-group member and neutral agent. These findings demonstrate that for young children, personal cost appears to be a greater inhibitor to compassionate responding than who compassion is directed toward.

A commentary on evidenced-based parenting programs: redressing misconceptions of the empirical support for Triple P.

A meta-analytic review of the Triple P-Positive Parenting program by Wilson et al., recently published in BMC Medicine, claimed to demonstrate that although Triple P is widely disseminated and adopted, the evidence attesting to the effectiveness of the program is not as convincing as it may appear. Although this review addresses the important issue of evaluation and reporting methods within evidence-based interventions, we contend that the Wilson et al. review contains a number of significant conceptual, methodological and interpretational inadequacies that render the key conclusions of their review problematic.

Body weight perception outweighs body weight when predicting shame, criticism, depression and anxiety for lower BMI range and higher BMI range adults.

This study examined the relationship between body weight shame, self-criticism and mental health for individuals across body weight ranges. In total 1695 participants completed a series of online measures and we used Structural Equation Modelling, to assess for the relationship between weight, perceived weight, social rank (social comparison, body weight shame, submissiveness) self-criticism (inadequate and self-hatred) and anxious and depressive symptoms. Results indicated that perceived body weight is more important than actual body weight in predicting body weight shame. Importantly, individuals classified in higher BMI ranges rely more on the self-hatred form of self-criticism which significantly predicts anxious and depressive symptoms.

Fear leads to suffering: Fears of compassion predict restriction of the moral boundary.

Empirical investigations into the psychological drivers of more or less expansive moral thinking are lacking from the psychological literature. One potential driver that warrants deeper investigation is compassion - a prosocial motivation to both identity and alleviate suffering. The current research examined the extent to which compassion, and fears of compassion, act as a driver and inhibitor, respectively, of a morally expansive mindset. We tested these associations across three studies (N = 749) and found robust support for our predictions. Specifically, stronger compassion to others, and greater fears of extending compassion to others, were linked to enhanced and reduced moral expansiveness, respectively. Moreover, over and above empathy and mindfulness, fears of compassion and compassion uniquely predicted moral expansiveness. Finally, compassion was found to consistently mediate the relationship between fears of compassion to others and moral expansiveness. Our findings further our understanding of the psychological factors that may drive and restrict morally expansive mindsets and hold implications for the broader domains of moral decision-making and prosocial motivation as well as the application of practices that are designed to facilitate a compassionate mindset (e.g., Compassionate Mind Training).

Promoting Positive Relationship Between Parents and Grandparents: A Randomized Controlled Trial of Group Triple P Plus Compassion in Vietnam.

In Vietnamese culture, grandparents are significantly involved in the upbringing of grandchildren. This involvement of grandparents entails lots of ambiguities and challenges. Boundaries between parents and grandparents are often unclear, and communication can be restricted due to power differentials, leading to inconsistent discipline. This study seeks to evaluate the efficacy of the Group Triple P-Positive Parenting Program plus Building Coparenting Alliance-a compassion-focused module to promote the parent-grandparents relationship. One hundred Vietnamese parents whose parents or parent in-laws provided care for their children were randomly assigned to either an intervention condition (n = 50) or a waitlist control condition (n = 50). Both groups were assessed at three time-points (pre-intervention, post-intervention, and 6-month follow-up). The short-term intervention effects were found across domains, including co-parenting conflict, parents' self-compassion, dysfunctional parenting, parenting self-efficacy, parental adjustment, child behavioral problems and child prosocial behaviors. Intervention effects on co-parenting conflict, parenting behaviors, and the child's prosocial behaviors were maintained at a 6-month follow-up. This study demonstrates the efficacy of Triple P plus compassion in promoting co-parenting relationships between parents and grandparents, enhancing parenting practice and child outcomes in Vietnamese families.

Does Self-Reassurance Reduce Neural and Self-Report Reactivity to Negative Life Events?

Whilst research has shown how self-criticism may increase both neural and self-report markers of negative emotion, less well-known is how self-reassurance-a compassionately-motivated cognitive self-relating style-may regulate negative emotion. Using fMRI, we invited participants to engage in self-criticism and self-reassurance toward written descriptions of negative life events (mistakes, setbacks, failures). Our results identify that neural markers of negative emotion and self-report markers of trial intensity during fMRI are down-regulated under conditions of self-reassurance, relative to self-criticism. Future work to control for autobiographical memory during this fMRI task is needed, as are controls for how well participants can engage in both thinking styles, to explore how memory/task engagement can contribute to self-reassurance and self-criticism. Engagement in self-reassurance can reduce the "sting" of negative life-events, both neural and self-report, which holds important implications for therapy.

Stressed, depressed, and rank obsessed: Individual differences in compassion and neuroticism predispose towards rank-based depressive symptomatology.

OBJECTIVES: As social creatures, we monitor our relative rank and/or status with others via social comparisons. Whilst research has identified perceptions of inferiority or 'low rank' relative to others is a robust predictor of depressive, anxious, and stress symptomology, to date individual differences have been ignored. We wish to provide empirical evidence to outline how differences across personality traits may interact with social rank variables to buffer or predispose towards depressive symptomology. METHODS: Across three independent samples (N = 595), we replicated a social rank model of mental health, and with our third sample (N = 200), we sought to investigate attenuating roles for neuroticism versus compassion with multiple moderated regression models. RESULTS: Neuroticism predicted greater levels of rank-associated depression, and compassion failed to function as a protective factor for rank-associated depression. However, a closer inspection of the original Big-5 factor structure positions this scale as a measure of 'interpersonal submissiveness' or 'conflict appeasement' rather than genuine compassion. CONCLUSIONS: Whilst it is necessary to delineate the conditions where compassion is appropriate and able to lead to positive mental health outcomes, we argue this cannot be addressed with the Big-5 measure of trait compassion. We call for future work to consider valid and reliable measures for compassion, such as the self-compassion scale, submissive compassion scale, and fears of compassion scale, to more fully address how compassion may protect against both rank-based comparisons and severity of depression. PRACTITIONER POINTS: Social rank mechanisms are robustly implicated in depression, anxiety, and stress. Clients who present as higher in neuroticism, inferiority, or submissiveness may be more prone towards rank-associated depression symptoms. Preliminary evidence suggests cultivation of genuine compassion can shift clients from a rank-focussed to a compassionate-focussed mentality, which aids mental health and fosters well-being.

Compassion-Focused Technologies: Reflections and Future Directions.

Compassion is a prosocial motivation that is critical to the development and survival of the human species. Cultivating compassion involves developing deep wisdom, insight, and understanding into the nature and causes of human suffering; and wisdom and commitment to take positive action to alleviate suffering. This perspective piece discusses how compassion relates to the context of modern technology, which has developed at a rapid pace in recent decades. While advances in digital technology build on humankind's vast capacity to develop practical tools that promise to enrich our lives and improve our social connections, in reality the effects are often far from benign. The motives underlying the development of many contemporary digital platforms seem rooted in competitiveness and capitalism; while modern social media and online platforms are having a profound and pervasive impact on the mental health and wellbeing of humans around the globe. Nonetheless, digital technology holds considerable potential to promote compassionate insight, wisdom, and prosocial behavior. We reflect on the current state of technology within human society and examine the notion of compassionate technologies; discuss how contemporary paradigm shifts such as the inclusive design movement may be harnessed to build tools and platforms that promote collective good and increase prosocial behavior; and highlight examples of initiatives that are harnessing modern technology to advance democracy, collective knowledge, and personal freedoms and agency.