Attachment-Based Compassion Therapy Research Articles

Cost-Utility of Attachment-Based Compassion Therapy (ABCT) and Mindfulness-Based Stress Reduction (MBSR) in the Management of Depressive, Anxious, and Adjustment Disorders in Mental Health Settings: Economic Evaluation Alongside a Randomized Controlled Trial

ObjectivesThe main objective of this paper was to examine the cost-utility of attachment-based compassion therapy (ABCT) compared to Mindfulness-Based Stress Reduction (MBSR) and treatment-as-usual (TAU) on patients with depressive and/or anxious disorder, or adjustment disorder with depressive and/or anxious symptomatology in terms of effects on quality-adjusted life years (QALYs) as well as healthcare costs from a public healthcare system perspective.MethodA 6-month randomized controlled trial was conducted. Ninety Spanish patients with mental disorders (depressive, anxious, or adjustment disorders) received 8 weekly group sessions of TAU + ABCT, TAU + MBSR, or TAU alone. Data collection took place at pre- and 6-month follow-up. Cost-utility of the two treatment groups (ABCT vs MBSR vs TAU) was compared by examining treatment outcomes in terms of QALYs (obtained with the EQ-5D-3L) and healthcare costs (data about service use obtained with the Client Service Receipt Inventory).ResultsBoth MBSR and ABCT were more efficient than TAU alone, although the results did not reach statistical significance. Compared to ABCT, MBSR produced an increase both in terms of costs (€53.69, 95% CI [− 571.27 to 513.14]) and effects (0.004 QALYs, 95% CI [− 0.031 to 0.049]); ICUR = €13,422.50/QALY). Both interventions significantly reduced the number of visits to general practice compared to TAU.ConclusionsThis study has contributed to the evidence base of mindfulness- and compassion-based programs and provided promising information about the cost-utility of MBSR for patients with emotional disorders. However, the small sample size and short follow-up period limit the generalizability of the findings.PreregistrationClinicaltrials.gov; NCT03425487.

Effectiveness of attachment-based compassion therapy to reduce psychological distress in university students: a randomised controlled trial protocol.

Higher education, particularly university, is a challenge for many students that can lead to their mental health being seriously affected. The stress to which they are subject throughout their time at university can lead to anxiety and depression. "Third wave" psychotherapies, including compassion-based therapy, have been used to improve psychological outcomes, such as stress, anxiety, emotional distress and well-being. There are some signs that third wave psychotherapies reduce psychological distress in university students, but more and higher-quality studies are needed. In this randomised controlled trial (RCT), we hypothesise that the provision of attachment-based compassion therapy (ABCT) will be more effective than an active control group based on relaxation therapy for improving psychological distress in university students. A two-arm RCT will be conducted involving 140 university undergraduate and postgraduate students from the University of Zaragoza and the National University of Distance Education (UNED) who reside in the autonomous community of Aragon, Spain. Interventions with either ABCT or relaxation therapy will be implemented, with an allocation ratio of 1:1 between groups. Both interventions will last six weeks and consist of six weekly group sessions lasting 1.5 h each. Data will be collected before and after the intervention, and there will be a follow-up at six months. The primary outcome will be psychological distress at post-intervention. Secondary outcomes will be depression, anxiety, stress and burnout symptoms, affectivity and emotional regulation. Attachment style, experiential avoidance, compassion (for others/oneself) and mindfulness skills will be measured as potential mechanistic variables. Intention-to-treat analysis will be performed using linear mixed regression models. The clinical significance of improvements will be calculated. Potential side effects will be monitored by an independent clinical psychologist. This study was approved by the Clinical Research Ethics Committee of Aragón. Participant data will remain anonymous, and results will be submitted to peer-reviewed open-access journals and disseminated via conferences. ClinicalTrials.gov, identifier NCT05197595.

Attachment-Based Compassion Therapy for Reducing Anxiety and Depression in Fibromyalgia.

Fibromyalgia patients often experience anxiety and depressive symptoms; however, validated interventions show only limited efficacy. This pilot study analyzed the effects of a 16-session version of attachment-based compassion therapy (ABCT-16) for improving anxiety and depressive symptomatology, as well as self-compassion and decentering, in 11 fibromyalgia patients. Scales were assessed at four time points: baseline, after sessions 8 and 16, and 3.5 months after the completion of the program. Significant improvements were found in all outcomes after the program, and most remained significant in the follow-up assessment. Our preliminary results suggest that ABCT-16 can be effective for improving anxiety and depressive symptomatology in fibromyalgia patients. Nonetheless, further studies with larger samples and control groups are necessary to confirm these results.

Assessing mindfulness and self-compassion facets as mediators of change in patients with depressive, anxious and adjustment disorders: Secondary data analysis of a randomized controlled trial

ObjectiveUnderstanding how different psychotherapies produce their effect can lead to identifying mechanisms of change that could be enhanced to produce better outcomes. This study aims at exploring the potential mediating role of mindfulness and self-compassion facets in the effect of mindfulness-based stress reduction (MBSR) and attachment-based compassion therapy (ABCT) for reducing general affective distress in a sample of patients with anxiety, depressive, and/or adjustment disorders. MethodNinety patients participated in a randomized controlled trial with three assessment points: baseline, posttreatment, and 6-months follow-up. The primary outcome was the ‘Depression, Anxiety, and Stress Scale’. The ‘Five Facets of Mindfulness Questionnaire’, and the ‘Self-Compassion Scale’ were used for assessing the corresponding facets as potential mediating variables. Path analysis models were computed, comparing each treatment to the treated as usual control group. Results and conclusionThe three facets of self-compassion were mediators of the effect of MBSR on affective distress and, in the case of ABCT, ‘Self-kindness’ was the only mediator. Thus, self-compassion facets seem to be potential mediators of MBSR; ‘Self-kindness’ would be the intermediary variable for ABCT's effect. Nevertheless, these results are exploratory and need to be replicated.

Positive effects and validation of a Brief Intervention Program of Attachment-Based Compassion Therapy

Objectives: In this study, we analyzed the validation and effects of a brief intervention of Attachment-Based Compassion Therapy (ABCT). Specifically, the aim of this study was to assess the efficacy of this brief protocol in improving compassion and other related variables.

Effectiveness of mindfulness-based stress reduction and attachment-based compassion therapy for the treatment of depressive, anxious, and adjustment disorders in mental health settings: A randomized controlled trial.

To study the effectiveness of attachment-based compassion therapy (ABCT) for reducing affective distress in a sample of outpatients with depressive, anxiety, or adjustment disorders, and to explore its mechanisms of action. This randomized controlled trial involved the assessment time points of pretreatment, posttreatment and 6-month follow-up. A total of 90 patients from three mental health units in Castellón, Spain, were recruited and randomly assigned to "ABCT + treatment as usual (TAU)," "Mindfulness-based stress reduction (MBSR) + TAU" or "TAU" alone. Affective distress, as measured by the "Depression, Anxiety and Stress Scales" (DASS-21) was the main outcome; self-compassion and mindfulness were also assessed. Multilevel mixed-effects models were used to estimate the effectiveness of the program, and path analyses were conducted to study the potential mechanistic role of mindfulness and self-compassion. ABCT was not superior to MBSR in any outcome or at any assessment point. ABCT was superior to TAU alone both posttreatment (B = -13.20; 95% confidence interval [CI]: -19.57, -6.84) and at 6-month follow-up (B = -7.20; 95% CI: -13.63, -0.76) for reducing DASS-21, and MBSR was superior to TAU alone both posttreatment (B = -11.51; 95% CI: -17.97, -5.05) and at 6-month follow-up (B = -8.59; 95% CI: -15.09, -2.10), with large effects (d ≥ 0.90). Changes produced by ABCT in DASS-21 were mediated by self-compassion, whereas changes produced by MBSR were mediated by both mindfulness and self-compassion. ABCT is effective for reducing affective distress in patients with anxiety, depressive and adjustment disorders, although its effect is not superior to that offered by MBSR. Self-compassion seems to be a significant mediator of the effects of ABCT.

Effectiveness of Internet Attachment-Based Compassion Therapy on Rumination and Fear of Coronavirus Disease in Elderly Women during Coronavirus Epidemics

Background and Objective: Based on the available data, the elderly people are the most vulnerable population during the coronavirus (COVID-19) epidemic since they both suffer from the disease and have to tolerate the quarantine that has been imposed to control the outbreak of the virus. Rumination is one of the most important variables during the COVID-19 epidemic due to the fact that people experience traumatic problems. The present study aimed to investigate the effect of Internet Attachment-based Compassion Therapy on rumination and fear of COVID-19 in elderly women during the epidemic. Materials and Methods: This was a quasi-experimental study with a pretest, posttest design, and a control group with a one-month follow-up. The statistical population included older women at Hamedan city, Iran, in 2020. The participants included 32 individuals who were randomly assigned into two groups of experiment (n=16) and control (n=16). The experiment group received eight sessions of Internet-based compassion treatment, and the control group did not receive any intervention. The data were collected using the Ruminative Response Scale to measure the fear of COVID-19 disease. The collected data were analyzed using SPSS software (Version 25) through one-way repeated measures analysis of variance and Bonferroni test, in two levels of descriptive (mean and standard deviation) and inferential statistics. Results: The analysis of obtained results in the post-test showed a significant decrease in rumination and fear of COVID-19 in the elderly women in the experiment group, compared to the control group during the pandemic. This result was consistent after a one-month follow-up (P<0.01). Conclusions: According to the results, it is recommended that health professionals and therapists use the Internet attachment-based compassion therapy approach along with other training and therapeutic approaches to decrease rumination and fear of coronavirus disease in the elderly women during the coronavirus epidemic.

Feasibility of the Internet Attachment-Based Compassion Therapy in the General Population: Protocol for an Open-Label Uncontrolled Pilot Trial.

BackgroundCompassion-based interventions delivered over the internet are showing promising results for the promotion of psychological health and well-being. Several studies have highlighted their feasibility, acceptance, and preliminary efficacy. However, this is an incipient field of research, and to the best of our knowledge, there are no data available from Spanish-speaking countries.ObjectiveThe aim of this study is to investigate the feasibility, acceptance, and preliminary efficacy of the Internet Attachment–Based Compassion Therapy (iABCT), a web-based version of the Attachment-Based Compassion Therapy, in Spanish speakers from the general population.MethodsThis feasibility study features a single-arm, uncontrolled, within-group design with an embedded qualitative and quantitative process evaluation at baseline, immediately after the intervention and at the 3-month follow-up. A minimum of 35 participants from the general population will be allocated to iABCT. Feasibility measures will include attrition rate, patterns of use of the web-based system, and participants’ acceptability, usability, and opinion. The primary outcome was measured using the Pemberton Happiness Index. Secondary outcomes were measured using the Compassion Scale, Self-Compassion Scale, Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short form, Five Facets of Mindfulness Questionnaire, Relationships Questionnaire, General Health Questionnaire, Non-Attachment Scale, International Positive and Negative Affect Schedule Short Form, Purpose-In-Life Test, and difficulties regarding the practice of compassion (Compassion Practice Quality Questionnaire). Mixed models will be used to evaluate primary and secondary outcome measures. A qualitative content analysis of the participants’ qualitative responses will also be performed.ResultsEnrollment started in February 2020 and will be finished in April 2020. Data analysis will start in October 2020.ConclusionsTo our knowledge, this study will, for the first time, show data on the feasibility, acceptability, and preliminary efficacy of web-based compassion (and self-compassion) training—that is, the adapted iABCT—in Spanish speakers from the general population. Further aspects of their implementation (ie, facilitators, barriers, and unwanted effects) and mechanisms of change will be investigated. This study will allow the revision and fine-tuning of the developed intervention, study design, and planning procedures, as well as the initiation of a future randomized controlled trial.Trial RegistrationClinicaltrials.gov: NCT03918746. Registered on April 17, 2019. Protocol version 1, 6 March 2019.International Registered Report Identifier (IRRID)PRR1-10.2196/16717

Comparison of the Effectiveness of Compassion-Focused Therapy and Attachment-Based Compassion Therapy on Blood Glucose Level and Medication Adherence in Diabetics

Background and Objectives: Diabetes is one of the most rampant chronic diseases that is accompanied by numerous psychological problems. The present study aimed to compare the effectiveness of compassion-focused therapy (CFT) and attachment-based compassion therapy (ABCT) on blood glucose level and medication adherence in diabetic patients. Materials and Methods: This quasi-experimental study was conducted based on a pretest and posttest design. At first, using the available voluntary sampling method, a number of 45 individuals were selected from 300 diabetic patients referred to Alborz Diabetes Association, Alborz, Iran. They were randomly divided into two experimental and one control groups. At the outset, in addition to the hemoglobin (Hb) A1c blood test, they completed a medication adherence questionnaire. Afterward, the first experimental group participated in eight two-h sessions of the compassionate therapy training course, and the second experimental group participated in 10 90-min sessions of the ABCT training course. All three groups received standard treatment for diabetic patients. At the end of the treatment, the HbA1c levels of blood in all three groups were re-evaluated, and again all patients completed the medication adherence questionnaire at the post-test stage. It should be mentioned that the collected data were analyzed using the analysis of covariance. Results: Based on the results, CFT and ABCT could reduce blood glucose level (HbA1c) (F=5.13, P<0.008, Eta= 0.20) and increase medication adherence (F=2.82, P<0.035, Eta= 0.12) in both of the experimental groups. Conclusion: The CFT and ABCT can be effective in improving medication adherence and blood glucose control (HbA1c) in diabetic patients. Therefore, it is suggested to provide such training together with other medical interventions as part of comprehensive therapy of diabetes.

Cost-Utility of Attachment-Based Compassion Therapy (ABCT) for Fibromyalgia Compared to Relaxation: A Pilot Randomized Controlled Trial.

A recent study has supported the efficacy of Attachment-Based Compassion Therapy (ABCT) compared to relaxation (REL) for the management of fibromyalgia (FM). The main objective of this paper is to examine the cost-utility of ABCT compared to REL in terms of effects on quality-adjusted life years (QALYs) as well as healthcare costs. Forty-two Spanish patients with FM received 8 weekly group sessions of ABCT or REL. Data collection took place at pre- and 3-month follow-up. Cost-utility of the two treatment groups (ABCT vs. REL) was compared by examining treatment outcomes in terms of QALYs (obtained with the EQ-5D-3L) and healthcare costs (data about service use obtained with the Client Service Receipt Inventory). Data analyses were computed from a completers, ITT, and per protocol approach. Data analysis from the healthcare perspective revealed that those patients receiving ABCT exhibited larger improvements in quality of life than those doing relaxation, while being less costly 3 months after their 8-week treatment program had ended (completers: incremental cost M, 95% CI = €−194.1 (−450.3 to 356.1); incremental effect M, 95% CI = 0.023 QALYs (0.010 to 0.141)). Results were similar using an ITT approach (incremental cost M, 95% CI = €−256.3 (−447.4 to −65.3); incremental effect M, 95% CI = 0.021 QALYs (0.009 to 0.033)). A similar pattern of results were obtained from the per protocol approach. This RCT has contributed to the evidence base of compassion-based interventions and provided useful information about the cost-utility of ABCT for FM patients when compared to relaxation. However, the small sample size and short follow-up period limited the generalizability of the findings.

Attachment-Based Compassion Therapy for Ameliorating Fibromyalgia: Mediating Role of Mindfulness and Self-Compassion

The aim of this study was to evaluate the efficacy of Attachment-Based Compassion Therapy (ABCT)—a standardised programme that includes practices to improve compassionate awareness with the aim of addressing maladaptive attachment—for improving mindfulness and self-compassion in fibromyalgia (FM) patients, and to determine whether gains in mindfulness and self-compassion mediate improvements in FM functional status together with comorbid anxiety and depression. The study comprised a randomised controlled trial of individuals undergoing ABCT, with a Relaxation condition as an active control group. Baseline, post-test, and 3-month follow-up assessments were included. Participants (n = 42) were FM patients randomly assigned to ABCT or relaxation. Outcomes were functional status (FIQ), anxiety (HADS-A), depression (HADS-D), mindfulness (FFMQ), and self-compassion (SCS). Differences between groups were estimated using mixed-effects regression models, and mediation analyses were conducted using path analyses. Compared with the Relaxation condition, the ABCT group was more effective for improving mindfulness and self-compassion, as it observed through changes in the FFMQ and SCS subscales. Effect sizes were in the moderately large to large range (Cohen’s d between 0.60–2.20). Reductions in FM functional status were not mediated by either mindfulness or self-compassion. However, the self-compassion facet of common humanity was a mediator for reductions in both anxiety (B = − 2.04; bootstrapped 95% CI = − 4.44, − 0.04) and depression (B = − 2.12; bootstrapped 95% CI = − 4.40, − 0.45). The improvement of common humanity via ABCT might be an active component for the reduction of comorbid anxiety and depression in FM patients. NCT02454244

Effects of attachment-based compassion therapy (ABCT) on brain-derived neurotrophic factor and low-grade inflammation among fibromyalgia patients: A randomized controlled trial

Fibromyalgia (FM) is a disabling syndrome characterized by chronic pain associated with fatigue. Its pathogenesis is unknown, but alterations in central sensitization, involving an imbalance of brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers, appear to be implicated. The aim of this study was to evaluate the impact of attachment-based compassion therapy (ABCT) on levels of BDNF, the inflammatory markers TNF-α, IL-6, IL-10, and the C-reactive protein (CRP), analysing whether biomarkers play a mediating/moderating role in improvements in FM functional status. Thirty-four female patients with FM participated in a RCT and were assigned to ABCT or relaxation therapy. Blood extractions were conducted at baseline and post-intervention, with self-report assessments of functional status (FIQ) at baseline, post-intervention and 3-month follow-up. A pro-inflammatory composite was obtained by summing up IL-6, TNF-α and CRP normalized values. Non-parametric tests, analysis of variance and regression models were used to evaluate treatment and mediation/moderation. Compared to relaxation therapy, ABCT showed significant improvements in FIQ and decreases in BDNF, CRP, and pro-inflammatory composite. Changes in BDNF had a mediating role in FIQ. ABCT seems to reduce BDNF and appears to have anti-inflammatory effects in FM patients. Reductions in BDNF could be a mechanism of FM functional status improvement.Clinical Trial Registration:http://ClinicalTrials.gov, identifier NCT02454244. Date: May 27th, 2015.

Attachment-based compassion therapy and adapted mindfulness-based stress reduction for the treatment of depressive, anxious and adjustment disorders in mental health settings: a randomised controlled clinical trial protocol

IntroductionDepressive, anxiety and adjustment disorders are highly prevalent among mental health outpatients. The lack of funding for mental health problems produces inefficient results and a high burden of disease. New...

Feasibility of the Internet Attachment-Based Compassion Therapy (iABCT)

Feasibility of the Internet Attachment-Based Compassion Therapy (iABCT)

Effects of Attachment-Based Compassion Therapy (ABCT) on Self-compassion and Attachment Style in Healthy People

Attachment-based compassion therapy (ABCT) is a new protocol of compassion based on attachment theory. The aim of this study was to assess the efficacy of this protocol for improving self-compassion in a healthy population and determine whether improvements in self-compassion mediate changes towards a more secure attachment style. The study consisted of a non-randomized controlled trial with an intervention group (ABCT) and a waiting list control group. In addition to pre- and post-intervention assessments, a 6-month follow-up assessment was included. Participants were healthy adults attending ABCT courses who self-rated as not having any psychological disorders and self-reported as not receiving any form of psychiatric treatment. Compared to the control condition, ABCT was significantly more effective for improving self-compassion as evidenced by changes on all subscales on the Self-Compassion Scale (SCS), except isolation. Effect sizes were in the moderate to large range and correlated with the number of sessions received. ABCT also led to improvements across all subscales of the Five Facets of Mindfulness Questionnaire (FFMQ), except describing. ABCT decreased psychological disturbance assessed using the General Health Questionnaire (GHQ-28) and decreased experiential avoidance assessed using the Acceptance and Action Questionnaire (AAQ-II). Furthermore, ABCT led to significant reductions in levels of anxiety and avoidance. Secure attachment style significantly increased in the ABCT group and was mediated by changes in self-compassion. In summary, ABCT may be an effective intervention for improving self-compassion and attachment style in healthy adults in the general populations.

Efficacy of "Attachment-Based Compassion Therapy" in the Treatment of Fibromyalgia: A Randomized Controlled Trial.

There is a growing interest in evaluating the effectiveness of compassion interventions for treating psychological disorders. The present study evaluated the effectiveness of "attachment-based compassion therapy" (ABCT) in the treatment of fibromyalgia (FM), and the role of psychological flexibility as a mediator of improvements. A total of 42 patients with FM were randomly assigned to ABCT or relaxation (active control group). Both the intervention and control condition were combined with treatment as usual (TAU). The primary outcome was functional status (FIQ), and the secondary outcomes were clinical severity (CGI-S), pain catastrophizing (PCS), anxiety (HADS-A), depression (HADS-D), quality of life (EQ-5D), and psychological flexibility (AAQ-II). Differences between the groups were estimated using mixed-effects models, and mediation assessments were conducted using path analyses. The ABCT group demonstrated superior outcomes compared to the relaxation group, including better FIQ values after treatment (B = -3.01; p = 0.003). Differences in FIQ were maintained at 3-month follow-up (B = -3.33; p = 0.001). The absolute risk reduction in ABCT compared to relaxation increased by 40.0%, with an NNT = 3 based on criteria of ≥50% FIQ reduction after treatment. Psychological flexibility had a significant mediating effect on improvements. These results suggest that ABCT combined with TAU appears to be effective in the treatment of FM symptoms. http://ClinicalTrials.gov, identifier NCT02454244.

Attachment-based compassion therapy

Compassion therapy is a third-generation psychotherapy that has been used in association with mindfulness in recent years. Similar to mindfulness protocols, a number of compassion protocols have been developed in the United States and Britain. As these countries have cultural characteristics and health systems that differ greatly from those of Spain, it was necessary to develop compassion protocols which were more suited to the Spanish situation and which could be administered to both general population and to medical and psychiatric patients. This model is based on attachment styles, a psychoanalytical concept which describes the relationship children develop with their parents, and which will influence the interpersonal relationships and self-image they will eventually develop. This paper describes the scientific basis for this model, the structure of the protocol, the scientific evidence and the training programme for this model, which is the first such programme specifically developed for Spanish-speaking countries.