The Prevalence and Benefits of Self-Compassion Among Professional Caregivers.

OBJECTIVE: Self-compassion is a healthy way of responding to challenges that may help long-term care professional caregivers (ie, nursing assistants and personal care aides) cope with stress, but its use may vary in important ways. This study explored the relationships between self-compassion and caregiver demographic characteristics, anxiety and depressive symptoms, and job satisfaction in a large racially/ethnically diverse sample of professional caregivers. DESIGN: Cross-sectional self-report questionnaire. SETTING AND PARTICIPANTS: A total of 391 professional caregivers, including nursing assistants and personal care aides from 10 nursing homes and 3 assisted living communities in New York, California, and North Carolina. METHODS: Professional caregivers were invited to complete an online questionnaire regarding stress and coping. Self-compassion was measured using the Self-Compassion for Youth Scale; anxiety and depressive symptoms were assessed using standardized screeners; and job satisfaction was assessed via an item used in a national survey. Self-compassion scores were represented by total scores and individual subscale scores. Analysis of variance was used to examine differences in self-compassion scores based on demographic characteristics, and correlation coefficients were used to explore relationships between self-compassion and mental health symptoms and job satisfaction. RESULTS: Significant differences were found in self-compassion based on age, race/ethnicity, place of birth, and education. In general, older caregivers, caregivers with higher education, and caregivers born outside the United States had the highest self-compassion, whereas White caregivers had the lowest self-compassion. Self-compassion was negatively associated with anxiety and depressive symptoms and positively associated with job satisfaction. CONCLUSION AND IMPLICATIONS: Professional caregivers' use of self-compassion to cope with challenges may depend on characteristics and life experiences influenced by their sociocultural background. Given the link between self-compassion and lower mental health symptoms and higher job satisfaction, it may be helpful to design and implement interventions with these differences in mind.

Feasibility, acceptability, and depression outcomes of a randomized controlled trial of Mindful Self-Compassion for Teens (MSC-T) for adolescents with subsyndromal depression.

INTRODUCTION: Adolescents are experiencing high rates of depressive symptoms, with negative consequences to their long-term health. Group-based, mindful self-compassion programs show promise in mitigating the development of more significant depression in at-risk adolescents. However, the lack of well-designed, active control conditions has limited the ability to examine the efficacy of such interventions. METHODS: Fifty-nine adolescents (Mage = 15.81, 70% female) with subsyndromal depressive symptoms from the Southeastern US were randomized to group-based Mindful Self-Compassion for Teens (N = 30) or a newly developed active control Healthy Lifestyles group (N = 29) during 2018 and 2019. Participants attended 8 weekly "main" sessions followed by 6 monthly continuation sessions. The feasibility and acceptability of participation in both groups were measured using attrition, attendance, credibility, and satisfaction data. Depression scores were collected weekly, and self-compassion scores were collected five times across 36 weeks. RESULTS: Both groups were equally feasible and acceptable during the 8-week program period; however, monthly continuation sessions were poorly attended in both groups. The risk of developing clinically significant depression was 2.6 times higher in the control group compared with the self-compassion group (p = .037) across 36 weeks. Depression significantly decreased in the self-compassion group, while it significantly increased in the control group. Both groups increased significantly in reports of self-compassion. These findings are on par with results noting the efficacy of cognitive-based interventions for high-risk adolescents; follow-up studies with larger sample sizes should be conducted to confirm these findings. CONCLUSIONS: Initial examination suggests Mindful Self-Compassion for Teens programming is feasible, acceptable, and efficacious in preventing the development of clinically significant depression in adolescents with subsyndromal depression. Future studies may benefit from refinements to the self-compassion measurement and/or the attention control condition; moreover, larger sample sizes are needed to confirm results.

Easing the burden of dementia caregiving: Protocol development for a telephone-delivered mindfulness intervention for rural, African American families.

Background: There have been few interventions targeted for rural African American (AA) caregivers of persons with dementia despite their unique cultural, geographic, health-related and socio-economic needs, including relatively less access to-and willingness to engage with-formal supports and resources. One effective intervention, Mindfulness-based stress reduction (MBSR), has been found to be culturally acceptable in AA populations; however, no studies have assessed feasibility, acceptability and impact of an adapted mindfulness intervention targeting rural AA dementia caregivers. Aims: The purpose of this study is to 1) determine the feasibility and acceptability of a telephone-delivered mindfulness training intervention in decreasing caregiver burden among rural, AA, informal caregiving teams of people with dementia; 2) to explore the effects of the training on caregiver burden and relevant secondary outcomes for both caregiving team members, including emotional regulation, tolerance of uncertainty, emotional and physical health, family conflict within the informal caregiving team, and self-efficacy; and 3) to explore comfort with and willingness to adopt technologies to access mindfulness practices and existing caregiving educational resources. Methods: Our study utilizes a single-group, uncontrolled design to assess the feasibility and acceptability of telephone-delivered mindfulness training designed to alleviate burden for rural caregivers of AA individuals with moderate to severe dementia. A care partner-the person who provides additional help -is included in the intervention. The primary outcome is feasibility of the telephone-delivered mindfulness intervention as assessed by an 85% retention rate with completion of at least 6 of the intervention sessions. Pre- and post-participation interviews assess acceptability.

Certified nursing assistants' experiences with self-compassion training in the nursing home setting.

Certified nursing assistants (CNAs) in nursing home (NH) settings experience considerable work-related and personal stress. Self-compassion is a personal resource linked to improved stress coping and may be particularly relevant to health care workers. In this study, we explored NH CNA's experiences with self-compassion training based on their narrative replies. Twenty-two CNAs (100% female, mean age 48 years, 82% Black/African American) from 3 mid-sized, non-profit NHs in the Southeast US completed either a standard 8-week, 20 h self-compassion training or a 6-week, 6 h modified version designed for health care providers. Qualitative data analyses from post-training focus group discussions identified four themes pertaining to changes in: (1) stress management, (2) appreciation and support, (3) caregiver role, and (4) connection to others. Findings suggested self-compassion training is feasible and beneficial for the stressors that CNAs experience. In the era of COVID-19 and beyond, self-compassion training is a promising method to improve CNAs' well-being.

The design and methods of the OPTIMUM study: A multisite pragmatic randomized clinical trial of a telehealth group mindfulness program for persons with chronic low back pain.

Mindfulness-based stress reduction (MBSR) is an evidence-based non-pharmacological approach for chronic low back pain (cLBP), yet it is not readily available or reimbursable within primary care clinics. Primary care providers (PCPs) who wish to avoid prescribing opioids and other medications typically have few options for their cLBP patients. We present the protocol of a pragmatic clinical trial entitled OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness). OPTIMUM is offered online via telehealth and includes medical group visits (MGV) with a PCP and a mindfulness meditation intervention modeled on MBSR for persons with cLBP. In diverse health-care settings in the US, such as a safety net hospital, federally qualified health centers, and a large academic health system, 450 patients will be assigned randomly to the MGV + MBSR or to usual PCP care alone. Participants will complete self-report surveys at baseline, following the 8-week program, and at 6- and 12-month follow-up. Health care utilization data will be obtained through electronic health records and via brief monthly surveys completed by participants. The primary outcome measure is the PEG (Pain, enjoyment, and general activity) at the 6-month follow-up. Additionally, we will assess psychological function, healthcare resource use, and opioid prescriptions. This trial, which is part of the NIH HEAL Initiative, has the potential to enhance primary care treatment of cLBP by combining PCP visits with a non-pharmacological treatment modeled on MBSR. Because it is offered online and integrated into primary care, it is expected to be scalable and accessible to underserved patients. Clinical Trials.gov: NCT04129450.

Self-compassion training for certified nurse assistants in nursing homes.

BACKGROUND/OBJECTIVES: Certified nursing assistants (CNAs) who work in nursing homes (NHs) face significant work and personal stress. Self-compassion training has been shown to decrease stress postintervention in previous studies among healthcare providers and those in helping professions. This study examines the feasibility, acceptability, and preliminary outcomes of self-compassion training to address CNA stress and well-being. DESIGN: Pre-post intervention. SETTING: Three mid-size, nonprofit NHs in North Carolina. PARTICIPANTS: Thirty CNAs, with a mean age of 49, 96% of whom were female, and 83% black/African American. INTERVENTION: In one NH, participants received an 8-week, 2.5-h/session (20 h total) group intervention. At the time of recruitment for NHs 2 and 3, a briefer format (6-week, 1-h/session; 6 h total) became available and was preferred by CNAs, thus both NHs 2 and 3 participants received a 6-h group intervention. All interventions occurred in meeting rooms within participating NHs during shift changes. MEASUREMENTS: Intervention attendance, retention, and acceptability; self-compassion, stress, burnout, depression, and attitudes toward residents with dementia, and job satisfaction pre-, post-, 3-month post-, and 6-month postintervention were assessed. RESULTS: Attendance and program satisfaction were high, and attrition was low for both training formats. Self-compassion was significantly improved at all time periods (p < 0.001), and stress and depression improved significantly through 3 months (p < 0.05), but not 6 months. No statistically significant change in job satisfaction was noted. CONCLUSION: Self-compassion interventions are feasible and acceptable for CNAs working in NHs and show promise for managing stress and improving well-being and compassion toward residents. The briefer 6-h format may maximize participation, while still providing benefits.

Self-Compassion and Current Close Interpersonal Relationships: A Scoping Literature Review.

Objectives: In order to provide a broad overview of the body of peer-reviewed literature on self-compassion and close relationships, this scoping review describes how self-compassion relates to thoughts, feelings and behaviors within the context of current personal relationships between family members, romantic partners, friends, or others referred to as "close". Methods: Two reviewers independently screened peer-reviewed articles retrieved based on a defined search strategy within three online databases, extracted data from 72 articles that met inclusion criteria by consensus, and summarized findings thematically. Results: With few exceptions, self-compassion is positively associated with secure attachment, adaptive parenting behaviors, healthy family, romantic and friendship functioning, and constructive conflict and transgression repair behavior. In families, evidence suggests parent self-compassion is linked to supportive parenting behavior, which is in turn linked to higher levels of child self-compassion. Conclusions: Self-compassion is associated with a wide variety of close interpersonal relationship benefits. These associations may be complex and bidirectional, such that positive social relationships promote self-compassion, while self-compassion promotes relational and emotional well-being. For a deeper understanding of these nuances and to establish causality, future research should include heterogeneous samples, longitudinal designs, observational and multi-informant methodologies, and consider attachment style and personality trait covariates. The potential implications for interventional research are discussed.

Is parents' education level associated with adolescent self-compassion?

Self-compassion has been identified as a trait that correlates with robust mental health; specifically, less anxiety, depression and stress in both adolescents and adults. However, little is known about the parental and family factors that are associated with adolescent self-compassion that may promote or enhance the development of this stress-buffering trait. In this study, 1057 adolescents in grades 7-12 from two different school settings answered questions in an online survey that related to their parents' education level and their own self-compassion. Results indicated that fathers' education, but not mothers', was associated with adolescent self-compassion. Specifically, adolescents whose fathers had a college education only had the highest level of self-compassion; a significant difference was found between self-compassion of adolescents of fathers' with a college degree and those with a doctorate/professional degree. Adolescents whose fathers had less than a college education (some college, high school graduate) or more than a college education (masters or doctorate/professional degree) reported lower self-compassion. As parent education level may be a proxy for other factors such as socioeconomic status, parenting style, or parent-adolescent relationship closeness, further research is necessary that will measure these factors and parse out that which specifically is associated with self-compassion in adolescents.

Parent Self-Compassion and Supportive Responses to Child Difficult Emotion: An Intergenerational Theoretical Model Rooted in Attachment.

Self-compassion is an adaptive way of self-relating that entails tending to one's emotional pain with understanding and care. In this paper, we propose an intergenerational model explaining how self-compassion develops within the context of the parent-child relationship. Specifically, we posit that parents who have had supportive experiences with their own childhood caregivers develop a secure attachment and a high level of self-compassion. In turn, we propose that high self-compassion in parents promotes the parents' capacity to support their child when he or she experiences difficult emotions (e.g., anger, sadness). These responses promote the child's secure attachment, high self-compassion development and positive behavioral outcomes. A key area for future research is examining the potential link between parent self-compassion and responses to difficult emotions in the child. Given self-compassion can be enhanced through intervention, support for this model will have broad implications for interrupting intergenerational cycles of dysfunction caused by insecure attachment.

Adolescent Self-Compassion Moderates the Relationship Between Perceived Stress and Internalizing Symptoms.

INTRODUCTION: Self-compassion, a trait that involves responding to one's difficulties with care and concern, may offer unique stress coping benefits during the challenges of adolescence. METHODS: This cross-sectional study used survey data from a large adolescent sample within two U.S. school settings (N=1,057; 65% female; 68% white; mean age 14.7 years) to examine whether self-compassion buffers the impact of perceived stress on internalizing symptoms, and secondarily, if these relationships differ by gender. RESULTS: Regression analysis revealed self-compassion is inversely related to internalizing symptoms. Moreover, the relationship between stress and depression and anxiety symptoms differed by level of self-compassion. This moderation effect was similar between genders for depressive symptoms, but slightly greater in males compared to females for anxiety. CONCLUSIONS: These results add to our understanding of self-compassion as an adaptive emotion regulation strategy with potential benefits for youth experiencing stress. Further research is needed to confirm if moderation effects for anxiety differ by gender.

Why is announcement training more effective than conversation training for introducing HPV vaccination? A theory-based investigation.

BACKGROUND: Improving healthcare providers' communication about HPV vaccination is critical to increasing uptake. We previously demonstrated that training providers to use presumptive announcements to introduce HPV vaccination improved uptake, whereas training them to use participatory conversations had no effect. To understand how communication training changed provider perceptions and communication practices, we evaluated intermediate outcomes and process measures from our randomized clinical trial, with a particular focus on identifying mechanisms that might explain the announcement training's impact. METHODS: In 2015, a physician educator delivered 1-h in-clinic HPV vaccination recommendation trainings at 20 primary care clinics in North Carolina serving 11,578 patients age 11 or 12. Clinics were randomized to receive training to use "announcements" that presume parents are ready to vaccinate or "conversations" that invite dialog about vaccination. Training participants were 83 HPV vaccine providers. Pre- and post-training surveys assessed constructs from the theory of planned behavior (TPB), including providers' attitudes and subjective norms about HPV vaccination and their perceived behavioral control to recommend HPV vaccination. Surveys also assessed providers' perceptions of the announcement and conversation communication strategies. RESULTS: Both trainings improved TPB-related constructs, including providers' positive attitudes toward HPV vaccination, subjective norms, and perceived behavioral control to recommend the vaccine (all p < .001, Cohen's d = .62-.90). Furthermore, in both trainings, the amount of time providers reported needing to discuss HPV vaccination with parents decreased from pre-training to 1-month follow-up (mean = 3.8 vs. 3.2 min, p = .01, d = .28). However, announcement trainings outperformed conversation trainings on other measures. For example, providers who received announcement training more often reported that the communication strategy saved them time, was easy to use, helped them promote HPV vaccination as routine care, and increased HPV vaccination coverage in their clinics (all p < .05; d = .44-.60). CONCLUSIONS: Both announcement and conversation trainings improved providers' HPV vaccine-related perceptions. However, providers viewed announcements as easier to use and more effective, which may help to explain the success of this training approach. Future provider communication interventions should consider implementation outcomes, including acceptability, alongside more traditional TPB constructs. TRIAL REGISTRATION: clinicaltrials.gov, NCT02377843 . Registered on February 27, 2015.

Helping Dementia Caregivers Manage Medical Problems: Benefits of an Educational Resource.

BACKGROUND/RATIONALE: Family caregivers of people with dementia must attend to medical care needs of their relative, yet few available resources address comorbidities in dementia. Consequently, caregivers feel ill-equipped when medical concerns arise. In response, an educational resource-Alzheimer's Medical Advisor ( AlzMed)-was developed in 2 forms (website and book) and evaluated. METHODS: Family caregivers (143 website and 51 book) used an educational resource that provides information on medical problems, vital signs, pain, dehydration, and the healthcare system. Data were collected at baseline, 3 months, and 6 months regarding confidence in sign/symptom management, burden, depression, and anxiety. RESULTS: Caregivers reported significantly improved confidence and (for website users) decreased role strain. Anxiety and depression also decreased, although not significantly. Improved confidence related to a reduction in role strain and anxiety, and care recipients did not experience adverse events. CONCLUSION: An educational resource focusing on care of comorbid illness may benefit caregiver outcomes.

Self-Compassion: A Potential Path to Adolescent Resilience and Positive Exploration.

The adolescent developmental stage is characterized by multiple transitions, both physiological and environmental, and physical, cognitive and socioemotional growth that often leads to both challenges and opportunities. Developing coping strategies to contend with these challenges, such as strengthening resilience and being open to new experiences, can potentially facilitate traversing this developmental period with greater ease. Although previous research has supported the premise that self-compassion buffers the negative effects of these emotional challenges, little research to date has examined the link between strengths-based attributes such as resilience and curiosity/exploration (i.e., being open to and embracing new experiences) and self-compassion, and whether age or gender moderates these relationships. As such, the purpose of this study was to explore these relationships among a large adolescent sample. Results of 786 public school adolescents and 271 private school adolescents (68% white, 65% female, Mage=15.6) who responded to questions in an online survey indicated that self-compassion was positively associated with both curiosity/exploration and resilience, and gender moderated the relationship between self-compassion and resilience such that this association was stronger among males than females. Age did not moderate the relationship between self-compassion and either resilience or curiosity/exploration, indicating that self-compassion is associated with both resilience and curiosity/exploration at all ages across adolescence. Implications are that interventions that cultivate self-compassion among adolescents may strengthen resilience and curiosity/exploration, offering new and healthy ways to cope with these challenges leading to improved emotional well-being.

Young adult cancer survivors' experiences with a mindful self-compassion (MSC) video-chat intervention: A qualitative analysis.

Young adult cancer survivors (YACS) are a vulnerable population that reports high anxiety, social isolation, and feelings of inadequacy after cancer treatment completion. Mindful self-compassion (MSC) provides strategies for coping with suffering. We explored how MSC practices addressed the psychosocial needs of a nationally recruited YACS sample (N=20, all female, age M=27.00, various cancer types) that participated in an 8-week MSC video-chat intervention. Descriptive qualitative analysis of the intervention recordings revealed three YACS' psychosocial needs: peer isolation, body concerns, and health-related anxiety. MSC practices addressed these in a number of ways including: self-reliance for emotional support, common humanity within the YACS community, gratitude, self-kindness, and acceptance. Meanwhile, the body scan practice initially triggered distress for some; implications are discussed.

Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial.

OBJECTIVE: Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive "announcements" or participatory "conversations." METHODS: In 2015, we conducted a parallel-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (≥1 dose) for adolescents aged 11 or 12 years. RESULTS: The immunization registry attributed 17 173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%-9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37 796). CONCLUSIONS: Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.

Improving dementia diagnosis and management in primary care: a cohort study of the impact of a training and support program on physician competency, practice patterns, and community linkages.

BACKGROUND: Primary care physicians routinely provide dementia care, but may lack the clinical skills and awareness of available resources to provide optimal care. We conducted a community-based pilot dementia training intervention designed to both improve clinical competency and increase utilization of local dementia care services. METHODS: Physicians (N = 29) and affiliated staff (N = 24) participated in a one-day training program on dementia screening, diagnosis and management that included direct engagement with local support service providers. Questionnaires about their dementia care competency and referral patterns were completed before and 6 months after the training intervention. RESULTS: Physicians reported significantly higher overall confidence in their dementia care competency 6 months post-training compared to pre-training. The largest reported improvements were in their ability to educate patients and caregivers about dementia and making appropriate referrals to community care services. Participants also reported markedly increased use of cognitive screening tools in providing care. Community service providers recorded approximately 160 physician-initiated referrals over a 2 year-period post-training, compared to few beforehand. CONCLUSIONS: Combining a targeted physician practice-based educational intervention with community service engagement improves dementia care competency in clinicians and promotes linkages between clinical and community dementia care providers.

A medical home for children with insulin-dependent diabetes: comanagement by primary and subspecialty physicians--convergence and divergence of opinions.

OBJECTIVE: The purpose of this work was to examine pediatricians' and endocrinologists' views about management for routine preventive and acute care, diabetes-specific care, and family education and care coordination for children with insulin-dependent diabetes. METHODS: We conducted a mixed-mode survey of all of the pediatricians in 1 medicaid managed care network and all of the pediatric and adult endocrinologists who treat children with diabetes in North Carolina. RESULTS: Of the 201 pediatricians surveyed, 132 responded (65%). Among the 61 endocrinologists who treat children, 59% replied. Nearly all of the respondents agreed that primary care physicians should have responsibility for routine primary care (eg, well-child checkups, treating minor illnesses or injuries, and immunizations). Likewise, large majorities favored endocrinologists as leads for diabetes-specific care (eg, 94% for training in use of an insulin pump and 82% for training in use of a glucometer). Many generalists and subspecialists reported that specific aspects of diabetes care should be comanaged (eg, 31% for tracking of hemoglobin A1c). However, large proportions of pediatricians and endocrinologists expressed differing opinions about the primary responsibility for family education and care coordination and for specific diabetes services. For example, 80% of endocrinologists saw subspecialists as leads for monitoring blood sugar levels, whereas 52% of pediatricians favored comanagement. CONCLUSIONS: An effective medical home model of care depends on establishing clear lines of responsibility between the primary care physician and subspecialist. Our findings suggest that primary care physicians and subspecialists agree on who should lead most aspects of care for patients with insulin-dependent diabetes and that some aspects of care should be comanaged. However, primary care physicians and subspecialists did not agree either between or within disciplines on who should be more responsible for the basic aspect of monitoring of blood sugar levels. Approaches that recognize the appropriate division of care between primary care physicians and subspecialists, facilitate comanagement when it is needed, and reward the collaboration required to provide medical homes for patients should be investigated as models of care.