Self compassion is one of the pretty trendy topics in eating disorders. It is becoming part of many therapist treatment packages despite it not being in any of the evidenced based treatment programs. In fact, strident evidence based practitioners, such as Glenn Waller warn against the incorporation of self compassion as an indication of therapist drift. It is seen as somewhat the realm of fluffy bunnies rather than having a scientific base. I wonder if that is fair.
Self-compassion is a multi-dimensional construct based on the recognition that suffering, failure, and inadequacy are part of the human condition, and that all people—oneself included—are worthy of compassion. It is most eloquently written about by Kristen Neff who I often post about on the Redleaf Facebook page.
To move away from fluffy bunny idea (fans of Buffy the Vampire Slayer may recognise the image) we need to look at the science behind self compassion in the treatment of eating disorders? Bruan et al (2016) provide an overall review of the link between self compassion, eating disorder symptoms and body image. Of most interest to me were the studies on clinical samples, rather than on people who do not have eating disorders (although that is important for prevention). There are a number of studies looking at self compassion is patients with eating disorders. Overall the studies do indicate a correlation between self compassion and eating disorder symptoms. There is evidence that patients with eating disorders have less self compassion and a greater fear of self compassion than university students without eating symptoms. Ferreira, Matos, Duarte, & Pinto-Gouveia, (2014) found that self kindness explained 38% of the variance of symptoms. Kelly, Vimalakanthan, & Carter (2014) found that fear of self compassion predicted disordered eating more powerfully than BMI, self esteem or, a bit weirdly, self compassion.
Prospective studies have indicated that lower self compassion and fear of self compassion are significantly correlated with disordered eating. Those patients that increased self compassion during treatment exhibited the greatest drop in eating disordered scores over 12 weeks of treatment. Patients with binge eating appeared to benefit more from self compassion interventions than patients with restricting behaviours.
A pilot treatment study by (Gale, Gilbert, Read, & Goss, 2014) investigated a 16 week self compassion program in 139 outpatients with Eating Disorders in England. Significant improvements were observed in psychological distress, self-esteem, self-directed hostility, perceived external control; as well as weight and shape concerns, eating restraint, and cognitive and behavioural AN and BN symptoms. With respect to eating behaviours, binge eating and excessive exercise significantly improved, with marginal improvements for vomiting, laxative, and diuretic use. Those with BN and, to a lesser extent, EDNOS, derived substantially greater benefit from the intervention than those with AN.
In a study with patients with BED, Kelly & Carter (2014), randomised 41 patients to either a self compassion self help program (Goss 2011), a behavioural program based Cognitive Behavioural Therapy (using Overcoming Binge Eating by Fairburn 1995) or a wait list control. From the description this CBT was not delivered in an optimal format for this trial. Both intervention groups reduced weekly binge days relative to the control condition. The self-compassion intervention was most effective in reducing global ED pathology, weight, and eating concerns, and produced greater improvements in self-compassion than CBT or the wait list control group. Again, patients with a higher fear of self compassion did less well in Compassion Focused Therapy interventions. Unfortunately both Kelly and Carter (2014) and Gale et al are hidden behind a pay wall, so I couldn’t access the full article.
So, there is a small but growing base of evidence that would suggest a role for adding in a compassion focused therapy to the treatment of eating disorders. I am not sure I am ready for it to be a stand alone treatment, but it is certainly a set of skills that may be helpful particularly in BN and BED.
As always feedback and comments welcome.
Self-compassion is a multi-dimensional construct based on the recognition that suffering, failure, and inadequacy are part of the human condition, and that all people—oneself included—are worthy of compassion. It is most eloquently written about by Kristen Neff who I often post about on the Redleaf Facebook page.
To move away from fluffy bunny idea (fans of Buffy the Vampire Slayer may recognise the image) we need to look at the science behind self compassion in the treatment of eating disorders? Bruan et al (2016) provide an overall review of the link between self compassion, eating disorder symptoms and body image. Of most interest to me were the studies on clinical samples, rather than on people who do not have eating disorders (although that is important for prevention). There are a number of studies looking at self compassion is patients with eating disorders. Overall the studies do indicate a correlation between self compassion and eating disorder symptoms. There is evidence that patients with eating disorders have less self compassion and a greater fear of self compassion than university students without eating symptoms. Ferreira, Matos, Duarte, & Pinto-Gouveia, (2014) found that self kindness explained 38% of the variance of symptoms. Kelly, Vimalakanthan, & Carter (2014) found that fear of self compassion predicted disordered eating more powerfully than BMI, self esteem or, a bit weirdly, self compassion.
Prospective studies have indicated that lower self compassion and fear of self compassion are significantly correlated with disordered eating. Those patients that increased self compassion during treatment exhibited the greatest drop in eating disordered scores over 12 weeks of treatment. Patients with binge eating appeared to benefit more from self compassion interventions than patients with restricting behaviours.
A pilot treatment study by (Gale, Gilbert, Read, & Goss, 2014) investigated a 16 week self compassion program in 139 outpatients with Eating Disorders in England. Significant improvements were observed in psychological distress, self-esteem, self-directed hostility, perceived external control; as well as weight and shape concerns, eating restraint, and cognitive and behavioural AN and BN symptoms. With respect to eating behaviours, binge eating and excessive exercise significantly improved, with marginal improvements for vomiting, laxative, and diuretic use. Those with BN and, to a lesser extent, EDNOS, derived substantially greater benefit from the intervention than those with AN.
In a study with patients with BED, Kelly & Carter (2014), randomised 41 patients to either a self compassion self help program (Goss 2011), a behavioural program based Cognitive Behavioural Therapy (using Overcoming Binge Eating by Fairburn 1995) or a wait list control. From the description this CBT was not delivered in an optimal format for this trial. Both intervention groups reduced weekly binge days relative to the control condition. The self-compassion intervention was most effective in reducing global ED pathology, weight, and eating concerns, and produced greater improvements in self-compassion than CBT or the wait list control group. Again, patients with a higher fear of self compassion did less well in Compassion Focused Therapy interventions. Unfortunately both Kelly and Carter (2014) and Gale et al are hidden behind a pay wall, so I couldn’t access the full article.
So, there is a small but growing base of evidence that would suggest a role for adding in a compassion focused therapy to the treatment of eating disorders. I am not sure I am ready for it to be a stand alone treatment, but it is certainly a set of skills that may be helpful particularly in BN and BED.
As always feedback and comments welcome.
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