Kindness Matters: Investigating the mental and physical health benefits of self-compassion in diabetes

Abstract

Mood disturbances among diabetes patients are both common and problematic, compounding emotional suffering and potentially leading to complications in physical health. Despite high prevalence, however, current treatment options for the management of depression are limited; evidence for psychosocial interventions that concurrently improve both psychological and physiological health metrics is sorely lacking. The work presented in the context of this thesis sought to address this deficit by investigating the mental and physical health benefits of self-compassion in diabetes patients through a series of theoretical, cross-sectional, and experimental studies. The primary aims of this programme of study were to establish: (1) whether selfcompassion predicts better mental and physical health outcomes among diabetes patients and, if so, (2) whether a self-compassion intervention improved these outcomes for patients. The first contribution (Study 1) reviewed the literature pertaining to depression and low mood among diabetes patients and presented a theoretical rationale suggesting that self-compassion is well-suited to the challenges of diabetes selfmanagement, and that enhancing this characteristic should have psychological, behavioural, and physiological benefits. Study 2, a cross-sectional study conducted primarily with Type 1 diabetes patients then tested some of these hypothesized relationships. Analysis showed (1), that diabetes-specific distress was a better predictor of HbA1c than depression and (2), that self-compassion moderated the link between diabetes-specific distress and HbA1c such that the link between distress and poorer metabolic outcomes was weakened among those with greater trait selfcompassion. In Study 3, the effects of a brief self-compassion induction on mood and motivation to undertake a common health behaviour were tested in a laboratory study among healthy participants. While the self-compassion intervention improved mood, results were not consistent with the notion that self-compassion, compared to selfcriticism, would positively improve behavioural motivation, Thus, the final study (Study 4), a randomized controlled trial, tested the effects of a more substantial and standardized ‘dose’ of self-compassion training – mindful self-compassion. Analyses showed that the eight-week training intervention improved both psychological and physiological outcomes, with reductions in depression, distress, and HbA1c in the intervention arm; effects were sustained at three months follow-up. Taken together, these studies are the first to demonstrate that self-compassion both predicts and causes reductions in depression and diabetes-specific distress among diabetes patients while concurrently improving metabolic outcomes. The RCT provides further evidence that self-compassion is a characteristic that can be developed with training. However, while highlighting the relevance of self-compassion to a patient population that often struggles with mood issues and related complications, further work is required to understand the pathways by which benefits might be exerted; effects on behavioural motivations in the laboratory study were not clearly evident. Overall, while self-compassion may be an important clinical aid for assisting patients more effectively cope with the distress of their condition, further work is required to better understand mediating psychological, behavioural, and biological pathways.