Effectiveness of self-compassion-related interventions for reducing self-criticism: A systematic review and meta-analysis.

Self-criticism is the process of negative self-evaluation. High levels are associated with psychopathology and poorer therapeutic outcomes. Self-compassion interventions were developed to explicitly target self-criticism. The aim of this review was to estimate the overall effect of self-compassion-related interventions on self-criticism outcomes and investigate potential moderating variables. A systematic search of the literature identified 20 randomized controlled trials (RCTs) that met the inclusion criteria. Nineteen papers, involving 1350 participants, had sufficient data to be included in the meta-analysis. Pre- and post-data points were extracted for the compassion and control groups. Study quality was assessed using an adapted version of the Cochrane Collaboration's risk of bias tool, which concluded that studies were of moderate quality. Meta-analysis findings indicated that self-compassion-related interventions produce a significant, medium reduction in self-criticism in comparison with control groups (Hedges' g = 0.51, 95% CI [0.33-0.69]). Moderator analysis found greater reductions in self-criticism when self-compassion-related interventions were longer and compared with passive controls rather than active. The remaining moderators of forms of self-criticism, sample type, intervention delivery, intervention setting and risk of bias ratings were insignificant. Overall, the review provides promising evidence of the effectiveness of self-compassion-related interventions for reducing self-criticism. However, results are limited by moderate quality studies with high heterogeneity. Directions for future research indicate that more RCTs with active controls, follow-ups, consistent use and reporting of measures and diverse samples are needed.

The shaping of moral injury among UK military veterans of the wars in Afghanistan and Iraq.

OBJECTIVE: Research on 'moral injury'-the psychological wound experienced by military personnel and other 'functionaries' whose moral values are violated-has proliferated in recent years. Many psychological researchers, including those in the UK, have subscribed to an increasingly individualised operationalisation of moral injury, with medicalised criteria that closely mirrors PTSD. This trend carries assumptions that have not been comprehensively verified by empirical research. This study aims to explore UK military veterans' experiences of, and challenges to, their moral values in relation to their deployment experiences, without prematurely foreclosing exploration of wider systemic influences. METHOD: Twelve UK military veterans who served in Afghanistan and/or Iraq were interviewed, and the data were analysed thematically and reflexively. RESULTS: Three inter-related themes were generated: (1) 'you've been undermined', (2) 'how am I involved in this?' and (3) 'civilianised'. CONCLUSIONS: The analysis suggests that several assumptions privileged in moral injury research may be empirically contradicted, at least in relation to the experiences of UK military veterans. These assumptions include that moral injury is exclusively driven by individual, episodic acts of commission and omission, invariably leads to guilt and necessarily bifurcates into variants of either perpetration or betrayal. Instead, participants understood the moral violations they experienced as socially contingent. Rather than 'treating' moral injury as a disorder of thinking and feeling located within an individual, the socially contextualised understanding of moral injury indicated by this study's findings may prompt the development of psychological and social interventions that understand moral injury as the fallout of what occurs between people and within systems.

Feasibility and efficacy of an online compassion-focused imagery intervention for veterinarian self-reassurance, self-criticism and perfectionism.

BACKGROUND: Veterinarians report high levels of psychological distress and self-criticism. However, there is minimal research investigating psychological interventions for veterinarians. Evidence suggests that compassion-focused therapy is effective at reducing distress in those with high self-criticism. This study aimed to investigate the feasibility and preliminary effectiveness of a 2-week online compassionate imagery intervention for veterinarians. METHODS: A one-group repeated measures design was used with 128 veterinarians. Participants completed measures of perfectionism, self-criticism, self-reassurance and fears of compassion four times, at 2-week intervals (at baseline, pre-intervention, post-intervention and 2-week follow-up). Participants answered written questions about their intervention experience post-intervention. RESULTS: Content analysis of the qualitative data found the intervention to be acceptable and beneficial to participants. Overall, study attrition was 50.8%, which is reasonable for a low-cost intervention. Minimal differences were found between participants who dropped out compared to those who completed the intervention. Perfectionism, work-related rumination and self-criticism were significantly reduced post-intervention, and these effects were maintained at follow-up. Resilience and self-reassurance remained unchanged. Fears of compassion reduced over the baseline period and pre-post intervention, questioning the validity of the measure. CONCLUSION: Overall, in the context COVID-19, the intervention showed impressive feasibility and preliminary effectiveness. Randomised control trials are recommended as the next step for research to establish the intervention's effectiveness.

The power of positive thinking: Pathological worry is reduced by thought replacement in Generalized Anxiety Disorder.

Worry in Generalized Anxiety Disorder (GAD), takes a predominantly verbal form, as if talking to oneself about possible negative outcomes. The current study examined alternative approaches to reducing worry by allocating volunteers with GAD to conditions in which they either practiced replacing the usual form of worry with images of possible positive outcomes, or with the same positive outcomes represented verbally. A comparison control condition involved generating positive images not related to worries. Participants received training in the designated method and then practiced it for one week, before attending for reassessment, and completing follow-up questionnaires four weeks later. All groups benefited from training, with decreases in anxiety and worry, and no significant differences between groups. The replacement of worry with different forms of positive ideation, even when unrelated to the content of worry itself, seems to have similar beneficial effects, suggesting that any form of positive ideation can be used to effectively counter worry.

Delineating the Role of Negative Verbal Thinking in Promoting Worry, Perceived Threat, and Anxiety.

Worry is characterized by streams of verbal thoughts about potential negative outcomes. Individuals with high levels of worry (and particularly those with generalized anxiety disorder) find it very difficult to control worry once it has started. What is not clear is the extent to which verbal negative thinking style maintains worry. Our study aimed to disentangle the effects of verbal versus imagery based thinking, and negative versus positive worry-related content on subsequent negative intrusive thoughts. High worriers were trained to engage in imagery or verbal processing, focusing on either negative or positive outcomes of their current main worry. Both thinking style and valence of worry content influenced later negative intrusive thoughts that play a role in initiating worry episodes. In contrast, only valence influenced subjective ratings of worry outcomes (i.e., cost, concern, and ability to cope, although not probability), with positive valence leading to lower ratings, irrespective of thinking style.

Characteristics of worry in generalized anxiety disorder.

BACKGROUND & OBJECTIVES: Groups of clients and community volunteers with Generalized Anxiety Disorder (GAD) and clients with Panic Disorder were compared to a group with elevated worry but without GAD on a range of measures, to identify individual differences beyond a high propensity to worry. METHOD: Participants completed standardised questionnaires and a behavioural worry task that assesses frequency and severity of negative thought intrusions. RESULTS: Relative to high worriers, clients with GAD had higher scores on trait anxiety, depression, more negative beliefs about worry, a greater range of worry topics, and more frequent and severe negative thought intrusions. Relative to community volunteers with GAD, clients in treatment reported poorer attentional control. Compared to clients with Panic Disorder, clients with GAD had higher trait anxiety, propensity to worry, negative beliefs and a wider range of worry content. CONCLUSIONS: Results confirmed expectations of group differences based on GAD diagnostic criteria, but also revealed other differences in mood, characteristics of worry, and perceived attentional control that may play a role in the decision to seek treatment.

The extent and nature of imagery during worry and positive thinking in generalized anxiety disorder.

Clients in treatment for Generalized Anxiety Disorder (GAD) were compared to a control group to assess the extent and nature of imagery during worry or while thinking about a personally relevant positive future event. Two methods were used to assess mentation and were completed in counter balanced order within the worry and positive conditions. One method assessed the occurrence of imagery by requiring participants to categorize their mentation as verbal thoughts or images every 10 s. The other method involved participants estimating the duration of any imagery that occurred in the previous 10 s. Imagery during worry occurred less often than while thinking about a positive event for both groups, but GAD clients had a more pronounced deficit of imagery during worry than the control group. Images that occurred were briefer during worry than while thinking about a positive future event and were briefer in the GAD than the control group for both worry and positive conditions. The results thus confirmed that imagery is less common during worry in clients with GAD but also demonstrated that the imagery that does occur in GAD is briefer.