Self-Compassion - an Antidote to the Pathological Mechanisms in Eating Disorders?

91 Pages·2017·1.07 MB·English

Self-Compassion - an Antidote to the
Pathological Mechanisms in Eating Disorders?

An effectiveness study of Compassion Focused Therapy
for patients with longstanding eating disorders and
childhood trauma

Nina von Krogh Monclair & Malin Antonsen Wuttudal

A thesis for the Professional Program
Department of Psychology

UNIVERSITY OF OSLO

Spring 2017
I
II
Self-Compassion – an Antidote to the Pathological
Mechanisms in Eating Disorders?
An effectiveness study of Compassion Focused Therapy for patients with
longstanding eating disorders and childhood trauma

Nina von Krogh Monclair & Malin Antonsen Wuttudal

III
© Nina von Krogh Monclair & Malin Antonsen Wuttudal

2017

Self-Compassion – an Antidote to the Pathological Mechanisms in Eating Disorders?

Authors: Nina von Krogh Monclair & Malin Antonsen Wuttudal

Supervisor: Helene Amundsen Nissen-Lie

Co-supervisor: KariAnne Vrabel

http://www.duo.uio.no

Trykk: Reprosentralen, Universitetet i Oslo
IV
V
Summary
Authors: Nina von Krogh Monclair & Malin Antonsen Wuttudal
Title: Self-Compassion – an Antidote to the Pathological Mechanisms in Eating Disorders?
Supervisors: Helene Amundsen Nissen-Lie and KariAnne Vrabel (co-supervisor)

Background: At present, Cognitive Behavioural Therapy (CBT) is viewed as the most
effective evidence-based treatment for patients with eating disorders (ED). However, up to
half of patients with EDs do not respond to CBT, illuminating a knowledge gap concerning
the mechanisms involved in change for this group. Patients with a combination of
longstanding EDs and childhood trauma have been identified as in need of intensified
treatment (Vrabel, 2009). Compassion Focused Therapy (CFT) is a transdiagnostic treatment
approach, proposing Self-Compassion (SC) as a mechanism of change in psychopathology.
Fostering SC in patients can alleviate extensive shame and self-criticism, postulated to
underlie symptoms of both EDs and trauma.

Objective: This thesis followed the outcome and treatment processes of 37 patients with
longstanding EDs and childhood trauma, receiving CFT in an inpatient ED unit. We
investigated whether there was a relationship between SC in patients and relief in symptoms
of EDs, trauma and general distress. Outcome was defined as overall changes in symptoms
from pre to post treatment, and one-year follow-up. Treatment process was assessed by
weekly measures of symptoms and SC. Validated instruments measuring ED, trauma, general
distress, and SC were used. The data was analysed using multilevel growth curve analyses,
supplemented by calculations of clinically significant change and effect sizes. Data for the
thesis was obtained from the research group Hoffart/Wampold at Modum Bad, Research
Institute.

Results and conclusion: Results from growth curve analyses conveyed no significant change
in symptoms of trauma and general distress at one-year follow-up, but showed a tendency
towards significant change in symptoms of EDs (p = 0.09). SC was found to be a significant
predictor of change in all symptom measures, indicating that SC might be an important
mechanism of change, as suggested in CFT. Possible explanations for the findings, as well as
clinical implications, methodological strengths and limitations and future directions are
discussed.
VI
VII
Acknowledgements
This thesis is based upon our interest in the treatment of eating disorders. We are very
thankful for the opportunity given us by KariAnne Vrabel at Modum Bad to work as research
assistants, as well as for giving us access to data from this intriguing work. We would not
have been able to go through with this if it weren’t for you. You have been extremely
positive and supportive, as well as spending whole days teaching us how to conduct quite
complex analyses. A warm thank you to Helene Nissen-Lie for your invaluable assistance
when we were conducting even more analyses, for your ”contact me at any time”-attitude, as
well as for always giving solid advice and believing in us along the way. Training with our
supervisors enabled us to autonomously conduct the analyses in the study, making the whole
research experience quite empowering and interesting.

Thank you to our editors, Heidi Hilda Bull Hellenberg and Laila Matar, for saving us from
the perils of Norwenglish.

Nina would like to give a deepfelt thank to Siri G., for being more than I ever knew was
possible. Gros bisous to my beloved wife Katia, thank you for being my rock and light and
always supporting me, and thank you Symra, our daughter, with whom I can share all the
wonders of life. Last, but certainly not least, thank you Malin. We did it!

Malin would like to give thanks to Jonas, for your patience and great sense of humor, for
always being there, and for believing in me. I am grateful to have you in my life. A warm
thank you also to my friends and family, thank you for showing me what life is really about.
And Nina, thank you for the nourishing collaboration, I am glad we climbed this mountain
together.

VIII
IX
Table of contents
1 INTRODUCTION
1.1 Introducing eating disorders................................................................................ 1
1.2 Approaching eating disorders.............................................................................. 2
1.2.1 Diagnostic assessment of eating disorders............................................... 2
1.2.2 Prevalence and incidence......................................................................... 4
1.2.3 Treatment................................................................................................. 4
1.3 The combination of eating disorders and childhood trauma............................ 5
1.3.1 Definitions of childhood trauma.............................................................. 5
1.3.2 Complex trauma and eating disorders...................................................... 6
1.4 Shame as a central affect in eating disorders and
childhood trauma................................................................................ 8
1.5 Compassion Focused Therapy............................................................................. 9
1.5.1 Compassion Focused Therapy as a possible antidote to
shame and self-criticism in eating disorders......................................... 9
1.5.2 Compassion Focused Therapy and the regulation of affect................... 10
1.5.3 Treating of eating disorders through the lens of
Compassion Focused Therapy............................................................ 11
1.5.4 Self-Compassion as a mechanism of change......................................... 12
1.6 Aims of the current study and research questions........................................... 13

2 METHOD
2.1 Design and treatment.......................................................................................... 14
2.1.1 Design..................................................................................................... 14
2.1.2 Treatment............................................................................................... 14
2.2 Participants.......................................................................................................... 16
2.3 Therapists and Research Unit............................................................................ 17
2.3.1 Therapists............................................................................................... 17
2.3.2 Research Unit......................................................................................... 18
2.4 Measures.............................................................................................................. 18
2.4.1 Primary outcome variables..................................................................... 18
2.4.1.1 Eating disorder pathology....................................................... 18
2.4.1.2 Trauma.................................................................................... 19
2.4.1.3 General distress....................................................................... 20
2.4.2 Process variables.................................................................................... 21
2.4.2.1 Self-Compassion..................................................................... 21
2.4.3 Screening variables................................................................................ 22
2.5 Procedure............................................................................................................. 23
2.6 Analyses................................................................................................................ 23
2.6.1 Descriptive analyses............................................................................... 24
2.6.1.1. Effect size calculations........................................................... 24
2.6.1.2 Clinically Significant Change................................................. 24
2.6.2 Multilevel growth curve analyses.......................................................... 25
2.7 Ethical Considerations........................................................................................ 28

X