Compassion focused therapy for body weight shame

Abstract

This PhD thesis investigates the role of compassion in helping those who experience body weight shame. Many people feel ashamed about how they look, regardless of their actual body weight, and this can have negative impacts on mental health. The aim of thesis was to examine how effective compassion focused interventions are in helping those who struggle with feelings of body weight shame. The thesis used a range of study designs across the included chapters to examine this question, including a systematic review, a large-scale survey testing a theoretical model of compassion and body weight shame, as well as conducting a randomised controlled trial examining the efficacy of a novel 12-session Compassion Focused Therapy (CFT) program. This program of research provides novel insights into how we might be able to help those who experience body weight shame with compassion.The first chapter provides an overview of the program of research conducted as part of this PhD. The second chapter of this thesis comprises the literature review of the thesis, and is a systematic review of the current state of evidence for compassion-based interventions in assisting people who struggle with body weight shame. The systematic review was conducted according to PRISMA guidelines and 25 studies met inclusion criteria. Overall, compassion-based interventions were found to reduce body weight shame and improve levels of compassion, however, there is great variability in terms of populations targeted, durations of interventions, and theoretical models used to guide intervention development. One of the most promising forms of intervention identified by the review was Compassion Focused Therapy.The third chapter of this thesis examined the theoretical framework underpinning CFT and tested how social mentality theory predicts the relationship between weight and mental health. Specifically, we examined, using structural equation modelling, the relationships between weight, perceived weight, social rank (social comparison, body wight shame, submissiveness), self-criticism (inadequate and self-hatred), and anxious and depressive symptoms. In total 1,695 participants were recruited, and we were able to examine how this model operated in both lower and higher Body Mass Index (BMI) groups. Results indicated that the model had good fit for both groups, and the social rank factors predicted greater levels of anxiety and depressive symptoms. Importantly, we found perceived weight is more important than actual weight in predicating body weight shame, and that individuals with higher BMI relied more on the self-hatred form of self-criticism than the lower BMI group. Chapter four presents a feasibility trial of a newly developed 12-session CFT group program as an intervention to help with body weight shame for adults who are categorized as obese according to BMI guidelines. We used a mixed-methods approach, reporting on both qualitative and quantitative outcomes of the program. Overall, we found that the CFT program was able to reduce body weight shame, increase levels of self-compassion, and improve health-engaging behaviours. Qualitative feedback indicated the importance of the group dynamics to help with the de-shaming of body appearance for individuals. The results from this feasibility trial are promising, and future research should examine the efficacy of CFT in a randomised controlled trials (RCT) design.Chapter five presents the first RCT of the developed CFT manualized program to help those experiencing body weight shame who are categorized as obese according to BMI guidelines. We examined the efficacy of the CFT program using a multi-modal approach that included both self-report and physiological assessments across short-term (pre- and post-intervention), as well as long-term (3-month and 6-month follow-up). In total, 55 participants met eligibility for the study and were included in the RCT. Results indicated that the CFT intervention, compared to the control group, was found to significantly reduce body weight shame, increase levels of self-compassion, and reduce fears of compassion. This is the first demonstration of the effectiveness of CFT using an RCT design and provides support for this approach at helping individuals who experience body weight shame.The final chapter of the thesis then provides a general discussion, summarizing the program of research conducted, as well as providing suggestions for future research. Taken together, this thesis indicates the positive benefits CFT can have for those who experience body weight shame.