An exploration of compassion and eating disorders: a mixed methods approach

Compassion Focused Therapy (CFT) was specifically developed for people with high levels of shame and self-criticism, who have difficulties with self-reassurance and self-compassion. It draws on evolutionary theories, particularly attachment theory, and neuroscience research of affect regulation. CFT has promising results with people with depression, psychosis and chronic mental health difficulties. However, the use of CFT has not been explored with people with eating disorders, who tend to be very self-critical and prone to experiencing shame. Therefore the aim of this research was to explore compassion in relation to eating disorders. To facilitate this, three related studies were undertaken. The aims of these studies were to: 1) Evaluate the outcomes of introducing CFT into a standard treatment programme for people with eating disorders in order to establish whether CFT can be used with this group of individuals. 2) Investigate the outcomes of a stand-alone Compassionate Mind Training (CMT) programme within a self-help setting and to explore participants' experiences of the programme. 3) Explore experiences of compassion from others in childhood, and current self- compassion, of people with eating difficulties. A mixed methodology approach was adopted, with repeated questionnaire measures used to investigate the outcomes of the interventions, and qualitative methods (specifically Interpretative Phenomenological Analysis) to explore the experiences of the CMT programme and experiences of childhood and current compassion. The results of Study 1 confirmed that CFT can be integrated into a standard treatment programme for people with eating disorders, with significant improvements in the cognitive and behavioural symptoms and psychopathological aspects of eating disorders, and more general psychological distress. This approach was particularly beneficial for people with bulimia nervosa or atypical eating disorders. Study 2 demonstrated that a CMT programme, which introduced the evolutionary model underpinning CFT and the specific training exercises included within the therapy, led to improvements on a range of questionnaire measures assessing eating difficulties, well-being, shame and self-criticism. Even though the programme did not focus specifically on eating difficulties, weight and shape concern both significantly reduced. This suggests that helping people to be more self-compassionate can impact on eating psychopathology. The qualitative data showed that the participants found the programme acceptable and benefitted from learning about the evolution of the brain and affect regulation systems. They also describe benefitting from the exercises and working as a group, which helped to develop a sense of safeness and allowed them to share their experiences. Study 3 identified six main themes, three relating to childhood experiences of compassion and three to current self-compassion. Participants recalled having difficulties in dealing with emotions from a very early age. In particular, they described how there was an interaction between their own temperament (e.g. concealment or withdrawal) and allowing their parents to be more emotionally engaged with them. Participants also experienced difficulties with current self- compassion, instead they tended to experience self-criticism and shame, and often used food to soothe themselves, either by restricting their eating or binge eating. To conclude, the research presented in this thesis provides the first evidence to support the use of GFT and GMT with people with eating disorders. It is also the first to explore experiences of the GMT programme and of people's early experiences of compassion and current self-compassion.