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

Daniel Campos, Mayte Navarro-Gil, Paola Herrera-Mercadal, Laura Martínez-García, Ausiàs Cebolla, Luis Borao, Yolanda López-Del-Hoyo, Diana Castilla, Eva Del Río, Javier García-Campayo, Soledad Quero, Daniel Campos, Mayte Navarro-Gil, Paola Herrera-Mercadal, Laura Martínez-García, Ausiàs Cebolla, Luis Borao, Yolanda López-Del-Hoyo, Diana Castilla, Eva Del Río, Javier García-Campayo, Soledad Quero

Abstract

Background: Compassion-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.

Objective: The 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.

Methods: This 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.

Results: Enrollment started in February 2020 and will be finished in April 2020. Data analysis will start in October 2020.

Conclusions: To 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 registration: Clinicaltrials.gov: NCT03918746. Registered on April 17, 2019. Protocol version 1, 6 March 2019.

International registered report identifier (irrid): PRR1-10.2196/16717.

Keywords: compassion; feasibility studies; happiness; internet; meditation; self-criticism.

Conflict of interest statement

Conflicts of Interest: The authors declare that they have developed the iABCT, the web-based version of ABCT developed and validated by JG and MN in the conventional format. DC was provided with grants from the Generalitat Valenciana (VALi+d program; APOSTD/2018/055) to carry out the project, “Compassion-based Therapy and wellbeing: development of an Internet-based intervention”. The authors declare that the research is conducted in the absence of any commercial or financial interests.

©Daniel Campos, Mayte Navarro-Gil, Paola Herrera-Mercadal, Laura Martínez-García, Ausiàs Cebolla, Luis Borao, Yolanda López-Del-Hoyo, Diana Castilla, Eva del Río, Javier García-Campayo, Soledad Quero. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 14.08.2020.

Figures

Figure 1
Figure 1
A screenshot of the “Psicología y Tecnología” (Psychology and Technology) Web platform.

References

    1. Navarro-Gil M, Lopez-del-Hoyo Y, Modrego-Alarcón M, Montero-Marin J, van Gordon W, Shonin E, Garcia-Campayo J. Effects of attachment-based compassion therapy (ABCT) on self-compassion and attachment style in healthy people. Mindfulness. 2018;11(1):51–62. doi: 10.1007/s12671-018-0896-1.
    1. Wilson AC, Mackintosh K, Power K, Chan SW. Effectiveness of self-compassion related therapies: a systematic review and meta-analysis. Mindfulness. 2018;10(6):979–95. doi: 10.1007/s12671-018-1037-6.
    1. Kirby JN. Compassion interventions: The programmes, the evidence, and implications for research and practice. Psychol Psychother. 2017 Sep;90(3):432–55. doi: 10.1111/papt.12104.
    1. Kirby JN, Tellegen CL, Steindl SR. A meta-analysis of compassion-based interventions: current state of knowledge and future directions. Behav Ther. 2017 Nov;48(6):778–92. doi: 10.1016/j.beth.2017.06.003.
    1. Montero-Marín J, Navarro-Gil M, Puebla-Guedea M, Luciano JV, van Gordon W, Shonin E, García-Campayo J. Efficacy of 'Attachment-Based Compassion Therapy' in the treatment of fibromyalgia: a randomized controlled trial. Front Psychiatry. 2017;8:307. doi: 10.3389/fpsyt.2017.00307. doi: 10.3389/fpsyt.2017.00307.
    1. García-Campayo J, Navarro-Gil M, Demarzo M. Attachment-based compassion therapy. Mindfulness Compassion. 2016;1(2):68–74. doi: 10.1016/j.mincom.2016.10.004.
    1. García-Campayo J, Demarzo M. Mindfulness y compasión. La nueva revolución. Barcelona: Siglantana; 2015.
    1. Eriksson T, Germundsjö L, Åström E, Rönnlund M. Mindful self-compassion training reduces stress and burnout symptoms among practicing psychologists: A randomized controlled trial of a brief web-based intervention. Front Psychol. 2018;9:2340. doi: 10.3389/fpsyg.2018.02340. doi: 10.3389/fpsyg.2018.02340.
    1. Baer RA, Lykins EL, Peters JR. Mindfulness and self-compassion as predictors of psychological wellbeing in long-term meditators and matched nonmeditators. J Posit Psychol. 2012 May;7(3):230–8. doi: 10.1080/17439760.2012.674548. doi: 10.1080/17439760.2012.674548.
    1. Campos D, Cebolla A, Quero S, Bretón-López J, Botella C, Soler J, García-Campayo J, Demarzo M, Baños RM. Meditation and happiness: Mindfulness and self-compassion may mediate the meditation–happiness relationship. Pers Individ Dif. 2016;93:80–5. doi: 10.1016/j.paid.2015.08.040.
    1. Gilbert P. The origins and nature of compassion focused therapy. Br J Clin Psychol. 2014 Mar;53(1):6–41. doi: 10.1111/bjc.12043.
    1. Neff KD, Germer CK. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. 2013 Jan;69(1):28–44. doi: 10.1002/jclp.21923.
    1. Germer CK, Neff KD. Self-compassion in clinical practice. J Clin Psychol. 2013 Aug;69(8):856–67. doi: 10.1002/jclp.22021.
    1. Jazaieri H, McGonigal K, Jinpa T, Doty JR, Gross JJ, Goldin PR. A randomized controlled trial of compassion cultivation training: Effects on mindfulness, affect, and emotion regulation. Motiv Emot. 2014;38(1):23–35. doi: 10.1007/s11031-013-9368-z.
    1. Jazaieri H, Jinpa GT, McGonigal K, Rosenberg EL, Finkelstein J, Simon-Thomas E, Cullen M, Doty JR, Gross JJ, Goldin PR. Enhancing compassion: a randomized controlled trial of a compassion cultivation training program. J Happiness Stud. 2013;14(4):1113–26. doi: 10.1007/s10902-012-9373-z.
    1. Pace TW, Negi LT, Adame DD, Cole SP, Sivilli TI, Brown TD, Issa MJ, Raison CL. Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology. 2009 Jan;34(1):87–98. doi: 10.1016/j.psyneuen.2008.08.011.
    1. Pace TW, Negi LT, Dodson-Lavelle B, Ozawa-de Silva B, Reddy SD, Cole SP, Danese A, Craighead LW, Raison CL. Engagement with Cognitively-Based Compassion Training is associated with reduced salivary C-reactive protein from before to after training in foster care program adolescents. Psychoneuroendocrinology. 2013 Feb;38(2):294–9. doi: 10.1016/j.psyneuen.2012.05.019.
    1. Gonzalez-Hernandez E, Romero R, Campos D, Burychka D, Diego-Pedro R, Baños R, Negi L, Cebolla A. Cognitively-based compassion training (CBCT) in breast cancer survivors: a randomized clinical trial study. Integr Cancer Ther. 2018 Sep;17(3):684–96. doi: 10.1177/1534735418772095.
    1. Kemeny ME, Foltz C, Cavanagh JF, Cullen M, Giese-Davis J, Jennings P, Rosenberg EL, Gillath O, Shaver PR, Wallace BA, Ekman P. Contemplative/emotion training reduces negative emotional behavior and promotes prosocial responses. Emotion. 2012 Apr;12(2):338–50. doi: 10.1037/a0026118.
    1. Sansó N, Galiana L, Cebolla A, Oliver A, Benito E, Ekman E. Cultivating emotional balance in professional caregivers: a pilot intervention. Mindfulness. 2017;8(5):1319–27. doi: 10.1007/s12671-017-0707-0.
    1. Hofmann SG, Grossman P, Hinton DE. Loving-kindness and compassion meditation: potential for psychological interventions. Clin Psychol Rev. 2011 Nov;31(7):1126–32. doi: 10.1016/j.cpr.2011.07.003.
    1. Galante J, Galante I, Bekkers M, Gallacher J. Effect of kindness-based meditation on health and well-being: a systematic review and meta-analysis. J Consult Clin Psychol. 2014 Dec;82(6):1101–14. doi: 10.1037/a0037249.
    1. Singer T, Kok BE, Bornemann B, Zurborg S, Bolz M, Bochow C. The ReSource Project: Background, Design, Samples, and Measurements. Leipzig: Max Planck Institute for Human Cognitive and Brain Sciences; 2016.
    1. Dahlin C. Being with dying—cultivating compassion and fearlessness in the presence of death. J Palliat Med. 2010 Jan;13(1):88–9. doi: 10.1089/jpm.2010.9869.
    1. Krieger T, Martig DS, van den Brink E, Berger T. Working on self-compassion online: A proof of concept and feasibility study. Internet Interv. 2016 Nov;6:64–70. doi: 10.1016/j.invent.2016.10.001.
    1. Finlay-Jones A, Kane R, Rees C. Self-compassion online: a pilot study of an internet-based self-compassion cultivation program for psychology trainees. J Clin Psychol. 2017 Jul;73(7):797–816. doi: 10.1002/jclp.22375.
    1. Foresight Mental Capital and Wellbeing Project . Govrnment of UK. London: The Government Office for Science; 2008. [2020-03-09]. Mental Capital and Wellbeing: Making the Most of Ourselves in the 21st Century. .
    1. Neff KD, Costigan AP. Self-Compassion, Wellbeing, and Happiness Mitgefühl mit sich selbst, Wohlbefinden und Glücklichsein. Psychologie in Österreich. 2014;2(3):114–9.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA, PAFS consensus group CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Br Med J. 2016 Oct 24;355:i5239. doi: 10.1136/bmj.i5239.
    1. Eysenbach G, CONSORT-EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011 Dec 31;13(4):e126. doi: 10.2196/jmir.1923.
    1. Chan A, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013 Feb 5;158(3):200–7. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. American Psychiatric Association . Diagnostic And Statistical Manual Of Mental Disorders (DSM-5). Fifth Edition. Washington, DC: American Psychiatric Publishing; 2013.
    1. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005 Oct;4(4):287–91. doi: 10.1002/pst.185.
    1. Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004 May;10(2):307–12. doi: 10.1111/j..2002.384.doc.x.
    1. Sim J, Lewis M. The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2012 Mar;65(3):301–8. doi: 10.1016/j.jclinepi.2011.07.011.
    1. Labpsitec (Laboratory of Psychology and Technology) Psicología y Tecnología. Castellón (Spain): [2020-03-05].
    1. Mindfulness and Compassion Research Group. [2020-03-05].
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33;quiz 34.
    1. Borkovec TD, Nau SD. Credibility of analogue therapy rationales. J Behav Ther Exp Psychiatry. 1972 Dec;3(4):257–60. doi: 10.1016/0005-7916(72)90045-6.
    1. Campos D, Mira A, Bretón-López J, Castilla D, Botella C, Baños RM, Quero S. The acceptability of an internet-based exposure treatment for flying phobia with and without therapist guidance: patients' expectations, satisfaction, treatment preferences, and usability. Neuropsychiatr Dis Treat. 2018;14:879–92. doi: 10.2147/NDT.S153041. doi: 10.2147/NDT.S153041.
    1. Castilla D, Garcia-Palacios A, Miralles I, Breton-Lopez J, Parra E, Rodriguez-Berges S, Botella C. Effect of web navigation style in elderly users. Comput Hum Behav. 2016 Feb;55(Part B):909–20. doi: 10.1016/j.chb.2015.10.034. doi: 10.1016/j.chb.2015.10.034.
    1. Hervás G, Vázquez C. Construction and validation of a measure of integrative well-being in seven languages: the Pemberton Happiness Index. Health Qual Life Outcomes. 2013 Apr 22;11:66. doi: 10.1186/1477-7525-11-66.
    1. Pommier Elizabeth, Neff Kristin D, Tóth-Király István. The Development and Validation of the Compassion Scale. Assessment. 2020 Jan;27(1):21–39. doi: 10.1177/1073191119874108.
    1. Garcia-Campayo Javier, Navarro-Gil Mayte, Andrés Eva, Montero-Marin Jesús, López-Artal Lorena, Demarzo Marcelo Marcos Piva. Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS) Health Qual Life Outcomes. 2014 Jan 10;12:4. doi: 10.1186/1477-7525-12-4.
    1. Sommers-Spijkerman M, Trompetter H, Ten Klooster P, Schreurs K, Gilbert P, Bohlmeijer E. Development and validation of the forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short Form. Psychol Assess. 2018 Jun;30(6):729–43. doi: 10.1037/pas0000514.
    1. Asensio-Martínez Ángela, Masluk Barbara, Montero-Marin Jesus, Olivan-Blázquez Bárbara, Navarro-Gil Maria Teresa, García-Campayo Javier, Magallón-Botaya Rosa. Validation of Five Facets Mindfulness Questionnaire - Short form, in Spanish, general health care services patients sample: Prediction of depression through mindfulness scale. PLoS One. 2019;14(4):e0214503. doi: 10.1371/journal.pone.0214503.
    1. Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol. 1991 Aug;61(2):226–44. doi: 10.1037//0022-3514.61.2.226.
    1. Yárnoz-Yaben S, Comino P. Evaluación del apego adulto: análisis de la convergencia entre diferentes instrumentos [Assessment of adult attachment: Analysis of the convergence between different instruments] Acción Psicológica. 2011 Dec;8(2):67–85. doi: 10.5944/ap.8.2.191.
    1. Rocha KB, Pérez K, Rogríguez-Sanz M, Borell C, Obiols JE. Propiedades psicométricas y valores normativos del General Health Questionnaire (GHQ-12) en población general española. Int J Clin Heal Psychol. 2011;11(1):125–39.
    1. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997 Jan;27(1):191–7. doi: 10.1017/s0033291796004242.
    1. Feliu-Soler A, Soler J, Luciano JV, Cebolla A, Elices M, Demarzo M, García-Campayo J. Psychometric properties of the Spanish version of the nonattachment scale (NAS) and its relationship with mindfulness, decentering, and mental health. Mindfulness. 2016;7(5):1156–69. doi: 10.1007/s12671-016-0558-0.
    1. Thompson Er. Development and Validation of an Internationally Reliable Short-Form of the Positive and Negative Affect Schedule (PANAS) Journal of Cross-Cultural Psychology. 2016 Jul 26;38(2):227–242. doi: 10.1177/0022022106297301.
    1. García-Alandete J, Martínez ER, Nohales PS. Estructura factorial y consistencia interna de una versión española del Purpose-In-Life Test. Univ Psychol. 2013;12(2):517–30. doi: 10.11144/javeriana.upsy12-2.efci.
    1. Del Re AC, Flückiger C, Goldberg SB, Hoyt WT. Monitoring mindfulness practice quality: an important consideration in mindfulness practice. Psychother Res. 2013;23(1):54–66. doi: 10.1080/10503307.2012.729275.
    1. Little RJ. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988 Dec;83(404):1198–202. doi: 10.2307/2290157.
    1. Thabane Lehana, Mbuagbaw Lawrence, Zhang Shiyuan, Samaan Zainab, Marcucci Maura, Ye Chenglin, Thabane Marroon, Giangregorio Lora, Dennis Brittany, Kosa Daisy, Borg Debono Victoria, Dillenburg Rejane, Fruci Vincent, Bawor Monica, Lee Juneyoung, Wells George, Goldsmith Charles H. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol. 2013 Jul 16;13:92. doi: 10.1186/1471-2288-13-92.
    1. Preacher Kj, Hayes Af. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers. 2004 Nov;36(4):717–731. doi: 10.3758/BF03206553.
    1. Serrano-Aguilar P, Ramallo-Fariña Y, Trujillo-Martín MM, Muñoz-Navarro SR, Perestelo-Perez L, de las Cuevas-Castresana C. The relationship among mental health status (GHQ-12), health related quality of life (EQ-5D) and health-state utilities in a general population. Epidemiol Psichiatr Soc. 2009;18(3):229–39.
    1. Lindkvist M, Feldman I. Assessing outcomes for cost-utility analysis in mental health interventions: mapping mental health specific outcome measure GHQ-12 onto EQ-5D-3L. Health Qual Life Outcomes. 2016 Sep 20;14(1):134. doi: 10.1186/s12955-016-0535-2.
    1. Badia X, Roset M, Herdman M, Kind P. A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states. Med Decis Making. 2001;21(1):7–16. doi: 10.1177/0272989X0102100102.
    1. Mackintosh K, Power K, Schwannauer M, Chan SW. The relationships between self-compassion, attachment and interpersonal problems in clinical patients with mixed anxiety and depression and emotional distress. Mindfulness (N Y) 2018;9(3):961–71. doi: 10.1007/s12671-017-0835-6.
    1. Sander L, Rausch L, Baumeister H. Effectiveness of internet-based interventions for the prevention of mental disorders: a systematic review and meta-analysis. JMIR Ment Health. 2016 Aug 17;3(3):e38. doi: 10.2196/mental.6061.
    1. Heber E, Ebert DD, Lehr D, Cuijpers P, Berking M, Nobis S, Riper H. The benefit of web- and computer-based interventions for stress: a systematic review and meta-analysis. J Med Internet Res. 2017 Feb 17;19(2):e32. doi: 10.2196/jmir.5774.
    1. Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry. 2019 Feb;18(1):20–8. doi: 10.1002/wps.20610. doi: 10.1002/wps.20610.
    1. Krieger T, Reber F, von Glutz B, Urech A, Moser CT, Schulz A, Berger T. An internet-based compassion-focused intervention for increased self-criticism: a randomized controlled trial. Behav Ther. 2019 Mar;50(2):430–45. doi: 10.1016/j.beth.2018.08.003.
    1. Goetz JL, Keltner D, Simon-Thomas E. Compassion: an evolutionary analysis and empirical review. Psychol Bull. 2010 May;136(3):351–74. doi: 10.1037/a0018807.
    1. Real Academia Española . Diccionario De La Lengua Epanola. 22a. Madrid: Planeta Publishing Corporation; 2001.
    1. Real Academia Española . Diccionario De La Lengua Española. 23a. Madrid: Planeta Publishing Corporation; 2014.
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009 May;36(5):452–7. doi: 10.1016/j.amepre.2009.02.002.
    1. Orsmond GI, Cohn ES. The distinctive features of a feasibility study: Objectives and guiding questions. OTJR (Thorofare N J) 2015 Jul;35(3):169–77. doi: 10.1177/1539449215578649.
    1. Hollis-Walker L, Colosimo K. Mindfulness, self-compassion, and happiness in non-meditators: A theoretical and empirical examination. Pers Individ Dif. 2011 Jan;50(2):222–7. doi: 10.1016/j.paid.2010.09.033.
    1. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003 Apr;84(4):822–48. doi: 10.1037/0022-3514.84.4.822.
    1. Møller SA, Sami S, Shapiro SL. Health benefits of (Mindful) self-compassion meditation and the potential complementarity to mindfulness-based interventions: a review of randomized-controlled trials. OBM Integr Complement Med. 2018;4(1):1–1. doi: 10.21926/obm.icm.1901002.
    1. Gilbert P, Clarke M, Hempel S, Miles J, Irons C. Criticizing and reassuring oneself: An exploration of forms, styles and reasons in female students. Br J Clin Psychol. 2004 Mar;43(Pt 1):31–50. doi: 10.1348/014466504772812959.

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