Compassionate mind training and its relationship with perceived stress, poor mental health, self-compassion and benevolence

Sammanfattning: Background: University students and employees are two populations where stress-related problems, anxiety, and depression are increasing. Interventions must be found to reverse this trajectory and to improve mental health. Research on self-compassion and compassion training as a strategy to handle high levels of perceived stress, depression, and anxiety has increased internationally during the last years. Accessibility to new effective health programs is important to spur the development within this field of psychology and mental health forward. Further, testing different delivery formats is important both in regard to accessibility as well as cost and time efficiency. Aims: The purpose of this thesis was to develop a compassionate mind training intervention and examine its effects on mental health and stress-related problems in two groups of adults (university students and employees). Furthermore, the prosocial concept of benevolence was measured to increase the understanding of the concept and its relation to self-compassion, anxiety, depression, perceived stress, and emotional exhaustion. Four studies were performed. The aim of the first study was to evaluate the effects of compassionate mind training on stress-related problems in university students compared with affect-focused training. Study II’s aim was to evaluate the effect of compassionate mind training provided by a digital mental health solution using a smartphone application on stress-related problems in university students compared with an active control group following a mindfulness program using a smartphone application and a passive waitlist control group, respectively. In study III, the aim was to evaluate the effect of compassionate mind training on stress-related problems among employees in two work organizations compared with physical exercise. Study IV investigated the associations between the psychological concepts of benevolence and stress, mental ill-health, and self-compassion among employees. Study I: Comparing the effects of compassionate mind training to an affect-focused training on university students with self-defined high levels of stress. Study II: Comparing the effects of digital compassionate mind training to an active control consisting of digital mindfulness training and a passive waitlist control on university students with stress-related problems. Study III: Comparing the effects of compassionate mind training to physical exercise on employees with self-defined high perceived stress in two organizations. Study IV: Investigating the associations between the psychological concept of benevolence and perceived stress, mental ill-health (e.g., emotional exhaustion, anxiety, and depression symptoms), satisfaction with life, and self-compassion among employees in two datasets. Methods: A compassionate mind training program was developed and evaluated in randomized controlled trials (studies I, II and III) and the data were analyzed by mixed effects models. Study IV used a cross-sectional design. An informed consent form was filled out by all participants in each study. Study I included 55 Swedish university students (mean age = 26) randomized to compassionate mind training (n = 28) and affect-focused training (n = 27). Assessment was done at pre- and posttraining evaluating participants’ self-reports on a self-compassion scale short form (SCS-SF), hospital anxiety and depression scale (HADS), and perceived stress scale (PSS-14). Mixed-effects regression models were used to analyze data. Study II included 57 Swedish university students (mean age = 25) who were randomized to digitally provided digital compassionate mind training (n = 23), digital mindfulness training (n = 19), and a waitlist (n = 15). The primary outcomes involved the perceived stress scale (PSS-10) and self-compassion scale short-form (SCS-SF), and secondary outcomes involved the Toronto alexithymia scale (TAS-20) and the clinical outcomes in routine evaluation-outcome measure (CORE-OM). Data were analyzed with multilevel growth models that provide advantages when analyzing repeated measures data from randomized between-group design. Study III included 49 employees from two work organizations who were randomized to compassionate mind training (n = 25) and physical exercise (n = 24). The participants filled in a self-report on the self-compassion scale (SCS), the perceived stress scale (PSS-14), the hospital anxiety and depression scale (HADS) and the satisfaction with life scale (SWLS). Mixed-effect growth models were applied to analyze the data. Study IV consisted of two cross sectional studies including 571 employees based on two dataset from five work organizations and examined the association between a new measure of the concept of a benevolence scale (BS) and self-report measures of a perceived stress scale (PSS-14) and emotional exhaustion (MBI-EE), symptom checklist, core depression subscale (SCL-CD6), The hospital anxiety and depression scale (HADS), the self- compassion scale (SCS), and the satisfaction with life scale (SWLS). Data were analyzed using bivariate Pearson r correlations. Results: The results of study I showed that compassionate mind training and the affect- focused training did differ significantly on the outcome measures of depression (p = 0.02) but not on the other measures of self-compassion, perceived stress, and anxiety. Study II found no significant effects between the mindfulness group and the compassionate mind training group. However, both digitally provided compassionate mind training and mindfulness training increased self‐compassion (p < 0.001) and decreased alexithymia (p = 0.01), respectively, compared to the waitlist. Only compassionate mind training significantly reduced stress (p = 0.027) compared to waitlist. No significant effect was found on global psychological distress (p = 0.227) in any of the groups. Results of study III showed that compassionate mind training and the physical exercise did differ significantly on the outcome measure of self-compassion (p = 0.03) but not on any of the other measures: perceived stress, anxiety, depression, and satisfaction with life. In study IV, results showed that benevolence was significantly and negatively correlated with perceived stress (r = −0.392), depression symptoms checklist (r = −0.190) depression correlated with self-compassion (0.401). However, benevolence was not significantly associated with either satisfaction with life (r = 0.148) or anxiety (r = −0.199). Conclusions: Compassionate mind training delivered both in a group setting and using a smartphone application showed weak results in the included studies. Reasons for this could depend on various factors such as low statistical power due to small group sizes, or that the compassionate mind training intervention is not an effective method compared to the active control groups: affect-focused training, mindfulness, or physical exercise. The results could also depend on low baseline values on the outcome measures which does not give room for improvements. It shows that compassionate mind training can be effective using a smartphone to train self-compassion and decrease perceived stress, anxiety and depression symptoms compared to a waitlist. It was observed that self-assessed benevolence was symptoms (r = −0.310) emotional exhaustion (r = - −0.295) and significantly and positively associated weakly with emotional exhaustion and depression, and moderate associated with perceived stress and self-compassion but the finding have low statistical value due to the cross-sectional design. The compassionate mind training studied in the current thesis showed minimal or no effects on mental health measured as perceived stress, anxiety, depression, and self-compassion on the populations of university students and employees. More robust studies need to be conducted with larger samples. Future studies should preregister the plan for statistical analysis and have a careful screening procedure of the participants as well as a strategy for adherence to prevent and avoid attrition. Also, long-term follow up and mixed-method studies are needed to further evaluate the impact of compassionate mind training, investigating when, how, and for whom compassionate mind training is beneficial, as well as the role of benevolence in stress, mental health, and self-compassion.

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