Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries.

BACKGROUND: The COVID-19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on depression, anxiety and stress, and social safeness. METHODS: Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self-report measures of perceived threat of COVID-19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness. RESULTS: Perceived threat of COVID-19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID-19 on social safeness. These effects were consistent across all countries. CONCLUSIONS: Fears of compassion have a universal magnifying effect on the damaging impact of the COVID-19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.

Randomised controlled trial of the new short-term online emotion focused training for self-compassion and self-protection in a nonclinical sample.

The Emotion Focused Training for Self-Compassion and Self-Protection (EFT-SCP) is an intervention developed to increase skills of self-compassion and protective anger with the aim to decrease self-criticism. This novel intervention was developed on the basis of the latest findings on self-criticism from Emotion-focused therapy and previous programs cultivating compassion (namely Compassion Mind Training and Mindful Self-Compassion Program). According to existing research, simply cultivating self-compassion is not always sufficient in reducing self-criticism. Therefore, the EFT-SCP was designed to build self-compassion whilst developing protective anger to combat self-criticism. Our goal was to investigate the efficacy of this new, short-term, online EFT-SCP program in a non-clinical population. A randomized control trial was conducted with pre- and post-intervention measurements and two-month follow-up of self-compassion and self-criticism/reassurance. Convenience sampling was used to recruit participants through a snowballing technique on social media. A total of 123 participants were randomly allocated to the EFT-SCP intervention or to a control condition. The intervention group were instructed through emails to complete an EFT-SCP task every day for 14 consecutive days. The control group did not complete any tasks. Out of 123 participants, 31 from intervention group and 20 from control group completed all measurements. There was a significant effect of the EFT-SCP on increasing self-compassion and self-reassurance scores as reported at two-month follow-up. The EFT-SCP was also effective at reducing self-uncompassionate responding and self-criticism (specifically Hated self) with changes evident at two months post-intervention. These findings are encouraging and suggest that interventions designed to enhance self-compassion and decrease self-criticism can be delivered to broader populations without the direct contact with mental health professionals.

Self-Compassion Scale: IRT Psychometric Analysis, Validation, and Factor Structure - Slovak Translation.

The present study verifies the psychometric properties of the Slovak version of the Self-Compassion Scale through item response theory, factor-analysis, validity analyses and norm development. The surveyed sample consisted of 1,181 participants (34% men and 66% women) with a mean age of 30.30 years (SD = 12.40). Two general factors (Self-compassionate responding and Self-uncompassionate responding) were identified, whereas there was no support for a single general factor of the scale and six subscales. The results of the factor analysis were supported by an independent sample of 676 participants. Therefore, the use of total score for the whole scale would be inappropriate. In Slovak language the Self-Compassion Scale should be used in the form of two general subscales (Self-compassionate responding and Self-uncompassionate responding). In line with our theoretical assumptions, we obtained relatively high Spearman's correlation coefficients between the Self-Compassion Scale and related external variables, demonstrating construct validity for the scale. To sum up, the Slovak translation of The Self-Compassion Scale is a reliable and valid instrument that measures Self-compassionate responding and Self-uncompassionate responding.

Acoustic analysis of clients' expression of self-compassion, self-criticism, and self-protection within emotion focused therapy video sessions.

Introduction: When it comes to the non-verbal communication of emotions, it is apparent that the human voice is one of the main ways of expressing emotion and is increasingly important in psychotherapeutic dialog. There is ample research focusing on the vocal expression of emotions. However, to date the analysis of the vocal quality of clients' in-sessional emotional experience remains largely unexplored. Moreover, there is generally a gap within the psychotherapy literature in the understanding of the vocal character of self-compassion, self-criticism, and protective anger. Methods: In this study we investigated how clients vocally convey self-compassion, self-protection and self-criticism in Emotion Focused therapy sessions. For this purpose we investigated 12 commercially available Emotion Focused Therapy videos that employed a two chair or empty chair dialog. Praat software was used for the acoustic analysis of the most common features - pitch (known as fundamental frequency or F0) and intensity (voice amplitude, i.e., loudness). Results: Results showed that intensity was significantly higher for self-criticism and self-protection than for self-compassion. Regarding pitch the findings showed no significant differences between the three states. Discussion: More research analyzing acoustic features in a larger number of cases is required to obtain a deeper understanding of clients' vocal expression of self-compassion, self-protection and self-criticism in Emotion Focused Therapy.

The Effects of Virtual Reality on Enhancement of Self-Compassion and Self-Protection, and Reduction of Self-Criticism: A Systematic Review.

BACKGROUND: Virtual reality used for the treatment of mental health disorders is showing promising potential in clinical practice. Increasing self-compassion and self-protections and decreasing self-criticism have been identified as trans-diagnostic mechanisms helping to build a resilient self. The goal of this systematic review was to provide an overview of research studies about virtual reality while exploring its effectiveness in increasing self-compassion and self-protection and decreasing self-criticism. METHODS: On 6 December 2022, titles, abstracts, and, where available, keywords were searched in the following databases: PubMed, Scopus, and Web of Science. The inclusion criteria were: empirical study; quantitative methodology; outcomes measured, including self-compassion and/or self-protection, and/or self-criticism; pre/post and/or control group intervention measures of selected outcomes; participants aged 18 and above; application of virtual reality technology as part of the intervention; full study availability; and English language. Exclusion criteria were: ruminations related only to physical pain; self-protection in the context of physical survival; VR used to increase ruminations. RESULTS: Selection criteria were met by 19 studies (two randomized controlled trials, 16 longitudinal studies, and one case study) with an overall number of 672 participants. Results suggest that VR interventions targeting self-criticism, self-compassion, and self-protection might be effective for non-clinical (self-compassion) as well as clinical (self-criticism and self-protection) samples. DISCUSSION: The present systematic review partially supports the effectiveness of VR interventions on self-criticism, self-protection, and self-compassion. To properly answer the question of its effectiveness, more randomized control trials with larger samples from different populations are needed. The results are also limited by the variability of intervention protocols and the amount of exposure to VR. Other: This work was supported by the Vedecká grantová agentúra VEGA under Grant 1/0075/19. This systematic review has not been pre-registered.

Clients' Facial Expressions of Self-Compassion, Self-Criticism, and Self-Protection in Emotion-Focused Therapy Videos.

Clients' facial expressions allow psychotherapists to gather more information about clients' emotional processing. This study aims to examine and investigate the facial Action Units (AUs) of self-compassion, self-criticism, and self-protection within real Emotion-Focused Therapy (EFT) sessions. For this purpose, we used the facial analysis software iMotions. Twelve video sessions were selected for the analysis based on specific criteria. For self-compassion, the following AUs were significant: AUs 4 (brow furrow), 15 (lip corner depressor), and the AU12_smile (lip corner puller). For self-criticism, iMotions identified the AUs 2 (outer brow raise), AU1 (inner brow raise), AU7 (lid tighten), AU12_smirk (unilateral lip corner puller), and AU43 (eye closure). Self-protection was combined using the occurrence of AUs 1 and 4 and AU12_smirk. Moreover, the findings support the significance of discerning self-compassion and self-protection as two different concepts.

Differences Between High and Low Self-Critics in Compassionate Facial Expression.

The goal of this study was to identify differences between high and low self-critical participants in relation to compassionate facial expressions. Our convenience sample consisted of 151 participants aged 18-59 years old (M = 25.17; SD = 7.81). The highest and the lowest scoring participants in self-criticism were selected for final analysis (N = 35). Participants, at home alone, watched a short video stimulus eliciting compassion while their facial expressions were recorded using webcams. Out of the sample we selected the highest 10% and the lowest 10% of self-critical participants according to the Slovak norms of The Forms of Self-Criticizing/Attacking and Self-Reassuring Scale. Two certified Facial Action Coding System raters (FACS) coded the participants' muscular activity according to facial action units. The FACS analysis revealed that action units 4 - brow lowerer, 7 - lids tight, 43 - eyes closed, 45 - blink, 55 - head tilt left, and 56 - head tilt right occurred significantly less often in high self-critical participants than in low self-critical participants, controlling for the difference between the baseline and compassionate moments in the video stimulus. Our research found that participants high in self-criticism were less facially expressive than those low in self-critical when watching compassionate video.

Automated facial expression analysis of participants self-criticising via the two-chair technique: exploring facial behavioral markers of self-criticism.

Introduction: As self-rating scales are prone to many measurement distortions, there is a growing call for more objective measures based on physiological or behavioural indicators. Self-criticism is one of the major transdiagnostic factor of all mental disorders therefore it is important to be able to distinguish what are the characteristic facial features of self-criticizing. To the best of our knowledge, there has been no automated facial emotion expression analysis of participants self-criticising via the two-chair technique. The aim of this study was to detect which action units of facial expressions were significantly more often present in participants performing self-criticism using the two-chair technique. The broader goal was to contribute to the scientific knowledge on objective behavioural descriptions of self-criticism and to provide an additional diagnostic means to the existing self-rating scales by exploring facial behavioral markers of self-criticism. Methods: The non-clinical sample consisted of 80 participants (20 men and 60 women) aged 19 years to 57 years (M = 23.86; SD = 5.98). In the analysis we used iMotions's Affectiva AFFDEX module (Version 8.1) to classify the participants' actions units from the self-criticising videos. For the statistical analysis we used a multilevel model to account for the repeated-measures design. Results: Based on the significant results the self-critical facial expression may therefore comprise the following action units: Dimpler, Lip Press, Eye Closure, Jaw Drop, and Outer Brow Raise, which are related to contempt, fear, and embarrassment or shame; and Eye Closure and Eye Widen (in rapid sequence Blink), which are a sign that highly negative stimuli are being emotionally processed. Discussion: The research study need to be further analysed using clinical samples to compare the results.

The development of the revised COPE 68 inventory with English and Slovak versions.

Introduction: Although there have been several attempts at improving the COPE Inventory, the factor structure of the instrument is still in dispute. In addition, studies have shown low reliability coefficients for some of the first-order factors, with Mental Disengagement having the lowest factor loadings. In a recent study on the external validation of the instrument, two additional first-order factors were identified in the qualitative analysis, namely Self-care and Care for Others. Methods: Based on these arguments we created the Revised COPE 68 Inventory, changing some of the problematic items in the first order factor Mental Disengagement and adding items for the two new factors (Self-care and Care for Others). We then tested its reliability and performed factor analyses on the first and second-order factorial structure. The data were collected through social media in two languages, English and Slovak, using convenience and snowball sampling techniques. The English sample contained 834 participants with mean age 25.27 years (SD = 8.467) and the Slovak sample comprised 1,425 participants with mean age 33 years (SD = 14.59). For the statistical analyses we used Exploratory Structural Equation Model (ESEM) analyses with target rotation and WLSMV, Exploratory and second-order confirmatory factor analysis with the scores of the COPE Inventory and EFA. Results: The Revised COPE 68 inventory had a good fit for all 17 first-order factors in both languages, including for the new factors Self-care and Care for Others. It appears that the first-order factors form a three-factor solution in both samples, consisting of active coping, social-emotional coping and avoidant coping. The revised Mental Disengagement has better psychometric properties as well. Discussion: The Revised COPE 68 inventory was found to be a reliable multidimensional instrument for measuring various coping strategies in both the English and Slovak language versions.

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study.

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

Stressful Factors, Experiences of Compassion Fatigue and Self-care Strategies in Police Officers.

Police officers routinely face stressful and possibly traumatic events in their work which may result in them experiencing compassion fatigue. The aim of this study was to explore compassion fatigue experiences in police officers, along with the stressful factors that may lead to compassion fatigue and the coping strategies they use in combating compassion fatigue. The convenience sample of 41 police officers was recruited via social media focused on police work. Data were collected using an online battery of questionnaires with open-ended questions prompting them to share their experiences of compassion fatigue, stress factors and self-care strategies. The data were analysed using deductive (theoretical) thematic analysis. After identifying recurring statements, statements were coded using pre-existing individual codes, and each statement was categorized into the emerging domains, subdomains, categories and subcategories. The results described the stressful factors and experiences of compassion fatigue as well as coping strategies in the 7 domains described by Figley in Front Psychol 9:2793, 2002b: emotional, behavioural, personal relations, somatic, spiritual, cognitive and work performance.

Prevalence of compassion fatigue among helping professions and relationship to compassion for others, self-compassion and self-criticism.

INTRODUCTION: Helping professionals are at high risk of being affected by the negative aspects of helping such as compassion fatigue. To date, no study has provided a comprehensive overview of compassion fatigue and compared the prevalence among different helping professions. OBJECTIVES: The aim of this study was to explore the prevalence and differences in compassion fatigue among different helping professions. We also wanted to explore the relationship between compassion, self-compassion, self-criticism and compassion fatigue. METHODS: Six hundred and seven participants working in the helping professions were recruited. The sample consisted of 102 nurses, 44 doctors, 57 paramedics, 39 home nurses, 66 teachers, 103 psychologists, 40 psychotherapists and coaches, 76 social workers, 39 priests and pastors and 41 police officers. The data were collected using an online questionnaire battery measuring levels of compassion, self-compassion, self-criticism, compassion fatigue and compassion satisfaction. RESULTS: We found significant differences in compassion fatigue levels among various helping professions. No large differences were found in the compassion and self-compassion levels exhibited by professionals with medium versus low compassion fatigue scores. However, participants with higher levels of compassion fatigue scored higher in self-criticism. Self-criticism was found to be the best predictor of compassion fatigue. The effect of profession on compassion fatigue as mediated by self-criticism and self-compassion was significant. CONCLUSIONS: Based on the results, we recommend designing programs to combat compassion fatigue that teach helping professionals to better manage their work time and workload (hours per week with clients/patients) and learn healthier inner talk (less self-critical and more self-compassionate).

Psychometric Properties and Factor Structure of the Slovak Version of the Copenhagen Burnout Inventory.

BACKGROUND: Burnout is clinically significant because it has adverse consequences in the form of mental and physical illnesses and economic losses. The goal of the research study was to translate the Copenhagen Burnout Inventory (CBI) into Slovak and then assess its factor structure, reliability, validity, and psychometric properties. METHODS: We collected two convenience samples: one for the psychometric properties analysis and factor analysis, which consisted of 4789 participants, and the other for the validity analysis, which consisted of 458 participants. Data were collected online. The participants filled out the following questionnaires: Copenhagen Burnout Inventory (CBI), Oldenburg Burnout Inventory (OLBI), Professional Quality of Life Scale (PROQOL), and Secondary Traumatic Stress Scale (STSS). RESULTS: The CBI had very good reliability in both samples, calculated using Cronbach alpha coefficients (between 0.839 and 0.908). In terms of CBI validity, all the correlation coefficients between the scale and subscales were between moderately high and high and ranged from 0.505 to 0.859. Except for two items, CBI7 and CBI10, all the items fall into the original factors of the scale. CONCLUSIONS: The Slovak version of the Copenhagen Burnout Inventory is a statistically sound instrument with high coefficients of reliability as well as validity and has an acceptable factor structure.

Qualitative analysis of compassion fatigue and coping strategies among nurses.

Objectives: Nurses are considered to be at risk of experiencing compassion fatigue, which can affect their personal and professional lives. The aim of this study was to investigate stressful factors contributing to the development of compassion fatigue in nurses, their experiences of compassion fatigue, and the coping strategies they used to cope with compassion fatigue. Methods: The convenience sample of 86 nurses from Central Europe was recruited via social networking sites during the pandemic of COVID-19. Data collection was conducted via an online battery of questionnaires which included open-ended questions on the stressful factors, experiences, and coping strategies for compassion fatigue. The data were analysed using a theoretical thematic analysis based on Figley's descriptions of compassion fatigue. The initial data was read several times to identify recurring statements. Each statement was then categorized into the emerging domains, subdomains, categories, and subcategories. Results: The results of our study show that stressful factors, experiences, and coping strategies for compassion fatigue in nurses in Central Europe could be related to cognitive, emotional, behavioural, somatic, personal relations, spiritual, and work-related symptoms of compassion fatigue as identified by Figley and that these may resemble experiences of nurses in North America, Japan, and Spain. Conclusion: This study provides a detailed overview of the stressful factors, experiences, and coping strategies for compassion fatigue, which could be used to develop an early screening tool and interventions for alleviating compassion fatigue and for preventive adaptation of the health care system.

Short version of the Scale for Interpersonal Behavior: Slovak translation and psychometric analysis.

Assertiveness is a social communication skill and is related to the effectiveness of expressing oneself while respecting others. A lack of assertiveness is associated with various mental illnesses; hence the importance of being able to measure it reliably. The aim of the study was to translate the short version of the Scale for Interpersonal Behavior (s-SIB) into Slovak and subsequently test its factor structure and other psychometric properties. Our convenience sample consisted of 590 respondents from Slovakia, 22.71% of whom were men and 77.29% women. The data analysis consisted of a descriptive analysis, reliability analysis, factor structure analysis, Mokken analysis, and percentile norms. The scale showed good psychometric properties. Unlike the 4-factor solution for distress and performance in the original work, our findings showed that the general factor loadings were very good and that the bifactor model had the best fit in both cases (distress and performance). Mokken analysis indicated that the total scores for distress and perfromance and their constituent subscales can be used as proposed. In conclusion, the Slovak version of the s-SIB can be used as to measure the total score for assertiveness as well as the separate factors - Positive Assertion, Negative Assertion, Expression of and Dealing with Personal Limitations, and Initiating Assertiveness.

Qualitative Analysis of Chair Tasks in Emotion-Focused Therapy Video Sessions.

One of the key elements of Emotion-Focused Therapy (EFT) is decreasing self-criticism as a secondary, maladaptive emotion within two-chair interventions while simultaneously increasing self-compassion and self-protection as primary, adaptive emotions. Though the concepts of self-compassion, self-protection, and self-criticism are highly acknowledged within psychotherapy research, the verbal articulation of these constructs within therapy sessions is underinvestigated. Thus, this qualitative study aims to examine how self-criticism, self-protection, and self-compassion are articulated by clients in EFT video sessions. Consensual qualitative research was used for data analysis performed by two core team members and one auditor. Three similar domains were considered for all three concepts: behavioural, emotional, and cognitive aspects. The number of self-protection statements was the highest among the states. The behavioural aspect was the most dominant domain for self-protection with the major subdomain 'I tell you what I need'. For self-compassion, the cognitive aspect was the most significant domain containing eight subdomains, such as 'I see your bad circumstances'. The most frequent domain for self-criticism was the behavioural aspect consisting of the two subdomains 'I point out your wrong behaviours and I give you instructions'. The findings demonstrate the significance of promoting both self-compassion and self-protection to combat self-criticism. More studies of categorising a broader number of cases among various therapy approaches are necessary to develop a more detailed understanding of clients' verbalisation of self-compassion, self-protection, and self-criticism within therapy.

Emotion-Focused Mobile App for Promoting Self-Compassion, Self-Protection, and Self-Criticism.

The COVID-19 pandemic has changed our daily lives and restricted access to traditional psychological interventions. Hence there is an immediate and growing demand for accessible and scalable mental health solutions. Emotion-focused training for self-compassion and self-protection was developed and distributed using mobile phone technologies, and its effectiveness was tested. The available research sample consisted of 97 participants with a mean age of 26.06 years and a standard deviation of 10.53. Participants using the mobile app underwent a 14-day program aimed at reducing self-criticism while increasing self-compassion and self-protection. Pre- and post-measurements were collected. The results showed a statistically significant medium effect on self-compassion, self-criticism, and self-protection performance and a significant small effect on self-protection distress. The finding that a 14-day mobile app was able to foster well-being in the form of self-compassion, self-protection, and self-criticism is promising. It indicates the potential for individuals to obtain help through the use of remote tools such as MHapps for a fraction of the usual cost, at their own pace, and without other restrictions.

The impact of Emotion-focused training for emotion couching delivered as mobile app on self-compassion and self-criticism.

Introduction: Being self-compassionate is considered a beneficial emotion regulation strategy. Therefore, the acquisition of emotional skills can raise self-compassion levels and consequently reduce self-criticism. Methods: Hence, the goal of the current study was to develop a mobile app based on the empirically proven group version of Emotion-Focused Training for Emotional Coaching (EFT-EC) and test its effectiveness in reducing self-criticism and raising self-compassion and self-protection. The sample consisted of 85 participants, of whom 22.4% were men and 77.6% were women. The mean age was 32.53 (SD = 14.51), ranging from 18 to 74 years. The participants filled out the following scales immediately before and after using the fourteen-day mobile app: The Forms of Self-Criticizing/Attacking & Self-Reassuring Scale (FSCRS), The Sussex-Oxford Compassion for the Self Scale (SOCS-S), and The Short-form Version of The Scale for interpersonal behaviour (s-SIB). Results: Use of the 14-day EFT-EC mobile app significantly improved self-compassion and self-reassurance and significantly reduced self-criticism compared to pre- and post-measurements. Discussion: The results are promising as self-criticism is a transdiagnostic phenomenon observed in various kinds of psychopathology and reducing it may prevent the emergence of psychopathologies. Moreover, the mobile app intervention can easily be accessed by a wide range of users, without requiring the services of a mental health professional, and thereby reduces the potential risk of shame or stigmatization.

Randomized controlled trial of emotion-focused training for helping professionals.

Introduction: The aim of this study was to examine the short- and long-term effectiveness of the novel Emotion-focused Training for Helping Professions on levels of compassion fatigue (secondary traumatic stress & burnout), self-criticism, self-compassion, and compassion for others. Methods: A randomized controlled trial study was conducted. A total of 253 participants were recruited and randomly assigned to either the experimental group or the control group. The experimental group attended a 14-day online training. The control group did not perform any tasks. Results: Results showed that after completing the intervention the experimental group participants reported significantly lower scores for secondary traumatic stress, burnout and self-criticism, and higher scores for self-compassion and that these lasted for two months after completion. Compared to the control group, the experimental group participants had significantly lower scores of secondary traumatic stress, burnout, self-criticism, and higher scores of self-compassion after the intervention. No significant changes were found for the control group, except a significant increase in time in the reported score for one dimension of burnout - exhaustion. Discussion: The novel EFT-HP training was shown to be effective in reducing levels of compassion fatigue (secondary traumatic stress and burnout) and self-criticism and increasing self-compassion.