Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study.

OBJECTIVE: This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE). METHOD: Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion. RESULTS: The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up. DISCUSSION: Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE. PUBLIC SIGNIFICANCE: This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.

The Me and the Us of Emotions: a cluster-randomized controlled trial of the feasibility and efficacy of a compassion-based social-emotional learning program for children.

There are well-established benefits of social and emotional learning (SEL) programs for children within educational contexts. Combining social-emotional skills and compassion abilities has been seldomly done, and it may be valuable at individual and societal levels, for resilient, empathetic, and inclusive societies. This study explored the feasibility and efficacy of a program designed to promote socioemotional and compassion skills in children attending the 3rd and 4th grades, by using in-class dynamics complemented with serious games. This program, named "The Me and the Us of Emotions," is part of the Gulbenkian Knowledge Academies 2020 and consists of 10 group sessions embedded in the school curriculum. Using a cluster-randomized controlled trial design, school classes were allocated to intervention (classes, n = 8; children, n = 163) and control groups (classes, n = 6; children, n = 132). During the program, facilitators assessed adherence to the sessions' plan, attendance, dosage (i.e., how many sessions were delivered), and participant responsiveness. Children completed self-report measures of social-emotional skills and emotional climate at pre-, post-intervention, 3-month, and 6-month follow-ups. Results indicate that the program is feasible, with high adherence, high attendance rate, and participant responsiveness. Results also indicate empathy, soothing, and drive feelings to change from pre-intervention to all other assessment moments, for the intervention group only. Moreover, cooperation and threat changed over time for participants in both the control and the intervention groups. The current study offers empirical support for the feasibility and utility of a compassion-based social-emotional learning program on promoting children's empathy, and emotions of soothing and vitality in the school context. Thus, these findings contribute to recent research on the potential added value of compassion practices within an SEL program.

Mother-infant bonding in the first nine months postpartum: the role of mother's attachment style and psychological flexibility.

INTRODUCTION: Mother's bond to the infant in the postpartum period plays an important role in the subsequent mother-infant relationship and the infant's socio-emotional functioning. Several maternal characteristics, such as attachment style and psychological flexibility, may contribute to the quality of mother-infant bonding, though literature examining these variables is still scarce. The present study aimed to examine the impact of mother's attachment on mother-infant bonding in the first month postpartum and the mediating role of psychological flexibility on that association. METHODS: Participants were 226 mothers of an infant up to 9 months old, who reported on their own attachment style (in terms of anxiety, comfort with proximity, trust in others), psychological flexibility (in terms of openness to experience, behavioural awareness, valued action) and mother-infant bonding. RESULTS: Results showed that mother's attachment anxiety predicted a bond with the infant directly and indirectly via mother's psychological flexibility, specifically through behavioural awareness and valued action. Trust in others had an impact on mother-infant bonding through behavioural awareness, whereas comfort with proximity influenced mother-infant bond indirectly, via valued action. Finally, mothers' civil status, schooling and number of children were relevant to better understand the variance of our mediating and dependent variables. DISCUSSION: Our findings highlight the importance of mother's attachment and psychological flexibility in promoting the quality of mother-infant bonding, which can inform future intervention programmes targeting modifiable factors, such as psychological flexibility, to promote early positive parent-infant relationships, particularly for single, first-time mothers, with higher levels of education.

Next-generation sequencing of 12 obesity genes in a Portuguese cohort of patients with overweight and obesity.

We examined 12 monogenic obesity genes in 72 Portuguese individuals with overweight and obesity (class 1 and class 2), some of which with suspected genetic obesity, to identify known or unknown potential obesity variants. Genomic DNA was analyzed for variants in genes LEP, LEPR, MC4R, POMC, PCSK1, BDNF, NTRK2, SIM1, SH2B1, UCP3, GCG and ADCY3 through next generation sequencing (NGS). The impact of the rare variants was investigated in the ClinVar database and using in silico tools for prediction of pathogenicity. Four potential pathogenic missense variants were detected at the heterozygous state in five individuals: two in the ADCY3 gene, NM_004036.5:c.1153G > A (p.Val385Ile) (rs756783003) and NM_004036.5:c.1222G > A (p.Gly408Arg) (rs201606553), one in gene SH2B1, NM_001145795.1:c.127C > A (p.Arg43Ser) (rs547678855), and the fourth in gene POMC NM_000939.4:c.706C > G (p.Arg236Gly) (rs28932472), which was found in two individuals. Moreover, six rare variants near splicing sites were also identified, as well as eight rare synonymous variants. In summary, some potential pathogenic rare missense variants were identified, two of them in ADCY3 gene, the most recently identified gene as having a role in monogenic obesity. Further analysis should be performed to confirm the clinical relevance of these variants.

Children's Perspectives on Using Serious Games as a Complement to Promoting Their Social-Emotional Skills.

The use of serious games may be an appealing and complementary way to motivate curriculum-based social and emotional learning (SEL); still, investigation into this potential usefulness is scarce. This study aims to address the usefulness of serious games within the program 'Me and Us of Emotions'. Specifically, we analyzed the differences in children's satisfaction in sessions that did or did not use serious games as a complement to the intervention, explored the contribution of using serious games to the global satisfaction with the program, and explored children's qualitative feedback regarding the sessions. The participants were 232 children (122 boys and 110 girls) aged between 8 and 12 years old (M = 9.09, SD = 0.80). The measures were based on the subjective appraisals of the sessions made by the participating children, including quantitative and qualitative assessments of the degree of satisfaction of the participants. The results showed that there were similar levels of satisfaction with the sessions that did or did not use serious games as a complement to the program. However, only satisfaction with the sessions that used serious games (and not satisfaction with the sessions that did not use them) contributed significantly to explaining both the enjoyment of the activities and the interest in the subjects. Satisfaction with serious games was significantly and positively associated with fun, easiness, ability to understand the session, and ability to cope with emotions. Qualitative analysis showed three main themes, namely: positive aspects, negative aspects, and opportunities for improvement of the program. Overall, these results indicate that children's satisfaction with the 'Me and Us of Emotions' program is related to serious games, suggesting the relevance of using this complementary tool more often when intervening with younger generations.

Nurturing compassion in schools: A randomized controlled trial of the effectiveness of a Compassionate Mind Training program for teachers.

OBJECTIVES: Schools are experiencing an unprecedented mental health crisis, with teachers reporting high levels of stress and burnout, which has adverse consequences to their mental and physical health. Addressing mental and physical health problems and promoting wellbeing in educational settings is thus a global priority. This study investigated the feasibility and effectiveness of an 8-week Compassionate Mind Training program for Teachers (CMT-T) on indicators of psychological and physiological wellbeing. METHODS: A pragmatic randomized controlled study with a stepped-wedge design was conducted in a sample of 155 public school teachers, who were randomized to CMT-T (n = 80) or a waitlist control group (WLC; n = 75). Participants completed self-report measures of psychological distress, burnout, overall and professional wellbeing, compassion and self-criticism at baseline, post-intervention, and 3-months follow-up. In a sub-sample (CMT-T, n = 51; WLC n = 36) resting heart-rate variability (HRV) was measured at baseline and post-intervention. RESULTS: CMT-T was feasible and effective. Compared to the WLC, the CMT-T group showed improvements in self-compassion, compassion to others, positive affect, and HRV as well as reductions in fears of compassion, anxiety and depression. WLC participants who received CMT-T revealed additional improvements in compassion for others and from others, and satisfaction with professional life, along with decreases in burnout and stress. Teachers scoring higher in self-criticism at baseline revealed greater improvements post CMT-T. At 3-month follow-up improvements were retained. CONCLUSIONS: CMT-T shows promise as a compassion-focused intervention for enhancing compassion, wellbeing and reducing psychophysiological distress in teachers, contributing to nurturing compassionate, prosocial and resilient educational environments. Given its favourable and sustainable effects on wellbeing and psychophysiological distress, and low cost to deliver, broader implementation and dissemination of CMT-T is encouraged.

A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study.

BACKGROUND: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union's Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. OBJECTIVE: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. METHODS: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. RESULTS: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. CONCLUSIONS: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.

Understanding Uncontrolled Eating after Bariatric Surgery: The Role of Excessive Skin and Body Image Shame.

Excess skin and disordered eating behaviors are referred to as some of the major negative consequences of bariatric surgery as well as body image shame. This study sought to explore how discomfort with excessive skin, body image shame, psychological distress, eating-related psychopathology, and negative urgency interact to understand uncontrolled eating among woman submitted to bariatric surgery. A cross-sectional sample of 137 women was evaluated postoperatively through self-report questionnaires assessing discomfort with excess skin, body image shame, eating-related psychopathology, negative urgency, and uncontrolled eating in a hospital center in the north of Portugal. Pearson correlations and Structural Equation Modeling (SEM) were performed. Body image shame mediated the relationship between discomfort with excess skin and eating-related psychopathology. In turn, the relationship between eating-related psychopathology and uncontrolled eating was mediated by negative urgency. This study highlights the impact of excess skin and body image shame on eating behavior post-bariatric-surgery. Considering the proven impact of uncontrolled eating on weight-loss results post-surgery, understanding the mechanisms underlying this problem is highly important. Our findings provide helpful insight for multidisciplinary teams committed to providing care to bariatric patients struggling with body image and eating difficulties.

Negative social comparisons and social discomfort in dentofacial deformity: a cross-sectional study.

BACKGROUND: Patients with severe dentofacial deformities are more susceptible to psychological distress since they are more likely to be emotionally unstable, less sociable and have higher levels of anxiety and neuroticism. The aim of this study was to assess the relationship between dentofacial deformity, negative social comparisons, anxiety and discomfort in social situations due to face appearance in two independent samples. METHODS: The sample consisted of 136 patients (group A: 90 college students; group B: 46 patients with dentofacial dysmorphosis that require orthognathic surgery). The impact of dentofacial deformity was evaluated through the following questionnaires: scale of social comparison through the appearance of the face and the scale of anxiety and discomfort in social situations due to the appearance of the face. RESULTS: Group B showed higher levels of anxiety and discomfort than the college student's sample (P=0.004). Individuals with dentofacial dysmorphosis presented a greater degree of anxiety and discomfort than individuals without dentofacial dysmorphosis (P=0.002). Finally, skeletal pattern and social comparison predicted anxiety and discomfort in the group A (F [1.88]=7.270; P<0.05], but only social comparison emerged as a significant predictor of anxiety and discomfort in the group B (F [2, 42]=4.463; P<0.05). CONCLUSIONS: Patients with dentofacial deformity have higher levels of anxiety and discomfort. This deformity can be reduced with orthodontic-surgical treatment, which can promote improvements in social and interpersonal well-being.

The Three-Factor Eating Questionnaire-R21: a confirmatory factor analysis in a Portuguese sample.

The Three-Factor Eating Questionnaire (TFEQ) is one of the most widely used instruments to study different eating behaviors. It measures three types of eating behaviors namely: cognitive restraint, uncontrolled eating and emotional eating. The present study aims to evaluate the factor structure and reliability of the Portuguese version of the TFEQ-R21, using a confirmatory factor analysis (CFA). The sample includes 468 participants from the general population, with ages ranging from 18 to 60 years. Results from the CFA confirmed the TFEQ-R21 three-factor structure and the model revealed an acceptable fit to the data (χ2(186) = 443.211, p < 0.001; χ2/df = 2.329; CFI = 0.933; TLI = 0.925; RMSEA = 0.054; SMRS = 0.053). Multi-group analysis results support strong measurement invariance across genders. Furthermore, all three dimensions presented adequate psychometric properties. Overall, results support that the Portuguese version of the TFEQ-R21 is a useful, reliable and robust instrument to assess relevant eating behaviors.Level of evidence V, descriptive studies.

The Clinical Interview for Psychotic Disorders (CIPD): Preliminary results on interrater agreement, reliability and qualitative feedback.

Given the recent treatment paradigm shift in psychosis, focusing on the recovery process, new assessment tools are needed. The Clinical Interview for Psychotic Disorders (CIPD) is an integrative and comprehensive assessment tool for psychotic disorders. CIPD encompasses the evaluation of diagnosis, psychosocial correlates and most relevant comorbidities. The study's aims were to examine CIPD inter-rater reliability, the relationships between CIPD and other instruments assessing positive and negative symptoms and functionality, and to explore participants' qualitative feedback. The sample included 30 individuals with psychotic disorders, aged between 18 and 62 years old. Two experts in clinical psychology conducted the interviews and independently rated other assessment tools (PANSS, GAF and PSP) to determine severity of psychotic symptoms and levels of functionality. Results indicated high inter-rater reliability for the majority of CIPD items and agreement regarding diagnosis was between 73% and 93%. Moreover, positive and moderate to strong correlations were found between CIPD, PANSS, GAF and PSP. From the qualitative analysis five themes emerged, namely: CIPD applicability and utility, comparison with previous interviews, interviewer aspects, negative and positive aspects. Overall, these preliminary results suggest that CIPD is a reliable and valid assessment instrument that seems to be well suited for people with psychosis.

Association study of variants in genes FTO, SLC6A4, DRD2, BDNF and GHRL with binge eating disorder (BED) in Portuguese women.

A population based case-control study was conducted in Portuguese women with overweight/obesity to investigate the possible association of variants in genes FTO, SLC6A4, DRD2, BDNF and GHRL with binge eating disorder (BED). The distribution of seven polymorphisms was evaluated in 31 BED patients and 62 controls. No significant associations were found between polymorphisms and BED. Of interest, a markedly lower frequency of the FTO rs9939609 obesity risk A-allele was found in BED patients (0.290) in relation to the control group (0.402). Contrasting with anorexia nervosa and bulimia nervosa, our data suggest that rs9939609 A-allele has no potential role in BED.

Incorporating psychoeducation, mindfulness and self-compassion in a new programme for binge eating (BEfree): Exploring processes of change.

This study explores the efficacy of BEfree, a 12-session group intervention that integrates psychoeducation, mindfulness, compassion and value-based action, in a sample of overweight and obese women with binge eating disorder ( N = 31). We used repeated measures analyses of variance and explored processes of change in binge eating and eating psychopathology. At post-intervention, participants decreased in binge eating severity, eating psychopathology, external shame, self-criticism, psychological inflexibility, body image cognitive fusion and increased self-compassion and engagement with valued actions. These results were maintained at 3- and 6-month follow-up. The changes in binge eating were mediated by the changes in the psychological processes promoted by BEfree.

Processes of change in quality of life, weight self-stigma, body mass index and emotional eating after an acceptance-, mindfulness- and compassion-based group intervention (Kg-Free) for women with overweight and obesity.

This study examined the effectiveness of Kg-Free: an acceptance-, mindfulness- and compassion-based group intervention for women with overweight and obesity at post-treatment and 3-month follow-up and explored the psychological processes that underlie changes in quality of life, weight self-stigma, body mass index and emotional eating at post-treatment. Overall, 53 women completed Kg-Free. At post-treatment and 3-month follow-up, participants reported increased quality of life, mindfulness and self-compassion abilities and decreased weight self-stigma, emotional eating, shame, weight-related experiential avoidance, self-criticism and body mass index. Shame and self-criticism reductions were important mediators of changes in health-related outcomes, whereas weight-related experiential avoidance, mindfulness and self-compassion mediated changes in weight and eating-related outcomes.

The role of self-disgust in eating psychopathology in overweight and obesity: Can self-compassion be useful?

This study explores the relationship between self-disgust and eating psychopathology and whether self-compassion plays a mediator role on this relationship. Participants were 203 adults, from both genders, with overweight and obesity (MBMI = 31.17, standard deviation = 5.43). Women reported higher levels of self-disgust and eating psychopathology and lower levels of self-compassion than men. Path analysis results suggested that the effect of self-disgust on eating psychopathology occurred partially through one's inability to be self-compassionate. The results highlight the damaging role of self-disgust on eating psychopathology and the importance of developing a more compassionate attitude towards the self to promote healthy eating behaviors.

Early emotional memories and borderline symptoms: the mediating role of decentering

Several studies suggested that Borderline Personality Disorder is related to early invalidating and harsh environments, characterized by scarce experiences of warmth and safeness, and possibly traumatic shameful memories. On the other hand, the ability to take a stance and not get fused with one’s internal experiences seems to be linked to diminished psychopathology. This study aims to understand the relationship between early emotional memories (of warmth and safeness experiences and shameful traumatic events) and borderline symptoms. Moreover, intends to explore the mediator role of decentering on the relationship between early emotional memories and borderline symptoms in a sample of 304 subjects from general community. Results showed significant correlations between early emotional memories, decentering and borderline symptoms. Additionally, our findings suggest that decentering mediate, at least partially, the effect of early emotional memories on borderline symptoms. Taken together, these findings point out for the importance of promoting decentering abilities with patients presenting borderline features

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Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance.

OBJECTIVE(S): The aim of this study was to test a theory driven model in which pain acceptance (both pain willingness [PW] and activity engagement [AE]) mediates the relationships of mindfulness and selfcompassion with depressive symptoms, while controlling for pain intensity. METHODS: A path analysis was conducted using AMOS software to test a meditational model in a sample of women with chronic musculoskeletal pain (N = 231). RESULTS: Participants with higher levels of mindful awareness and selfcompassion presented lower levels of pain intensity and depressive symptoms, and higher levels of AE. PW did not significantly correlate with any variable in study. The mediation analysis showed that AE mediated the relationship between selfcompassion and depressive symptoms, independently from pain intensity. CONCLUSIONS: These findings seem to corroborate the hypothesis that selfcompassion is rooted in a motivational system, as it seems to correlate with less depressive symptoms through increasing the engagement with valued actions despite experiencing pain.

The weight of weight self-stigma in unhealthy eating behaviours: the mediator role of weight-related experiential avoidance.

Weight stigma plays a damaging role in the life of the individuals with overweight and obesity who may internalise the widespread stigmatisation messages. Weight self-stigma is defined as personal experiences of shame, negative self-evaluations as well as perceived discrimination. It has been found to be related to experiential avoidance patterns and poorer outcomes. The current study aims to conduct a confirmatory factor analysis (CFA) on the Weight Self-Stigma Questionnaire (WSSQ) and explore its psychometric properties. Furthermore, the mediator role of weight-related experiential avoidance on the relationship between weight self-stigma and unhealthy eating behaviour was analysed. Concerning the CFA, the sample comprised 331 women with overweight and obesity seeking nutritional treatment. A second independent sample of 58 overweight and obese women was used to assess WSSQ's temporal validity and internal responsiveness. Results supported the WSSQ two-factor structure and good psychometric properties and responsiveness to change. Also, evidence was found for the mediator role of weight-related experiential avoidance on the relationship between BMI, weight self-stigma and unhealthy eating patterns in women with overweight and obesity. Overall, the current study showed that WSSQ is a reliable measure and highlights the important role of weight self-stigma and weight-related experiential avoidance in women with overweight and obesity. Level of evidence: Level V, descriptive studies.

BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion.

Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow-up assessments. Developing mindfulness and self-compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation-, mindfulness-, and compassion-based components for treating women with binge eating and obesity. OBJECTIVE: To test the acceptability and efficacy up to 6-month postintervention of a psychological program based on psychoeducation, mindfulness, and self-compassion for obese or overweight women with BED. DESIGN: A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3- and 6-month follow-up. RESULTS: BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self-criticism, body-image psychological inflexibility, and body-image cognitive fusion; and in improving obesity-related quality of life and self-compassion when compared to a WL control group. Results were maintained at 3- and 6-month follow-up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences. CONCLUSIONS: These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self-compassion when treating BED in obese or overweight women. KEY PRACTITIONER MESSAGE: The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree); Developing mindfulness and self-compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity; Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6-month postintervention.