Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors

Figures & data

Figure 1. Participant flow diagram and recruitment numbers.

Table 1. Participant characteristics at baseline by condition, presented as Mean (SD) or number of participants (%).

Characteristics	MyCB (n = 39)	MyCB + M (n = 17)	EW (n = 23)	p
	No. BCS (%)	No. BCS (%)	No. BCS (%)
Age, years – mean (SD)	57.54 (13.64)	60.88 (8.42)	57.39 (9.53)	0.57
Marital Status
Partnered	29 (47)	15 (24)	18 (29)	.59^+
Not partnered	10 (56)	2 (12)	5 (29)
Recruitment Source
BCNA	28	9	20	.33^+
Facebook	3	1	2
Breast Cancer Now	2	3	0
Other	6	4	1
Employment Status
Employed	21 (53)	6 (15)	13 (32)	0.35
Unemployed	18 (46)	11 (28)	10 (26)
Education
Less than high school^1	11 (73)	2 (13)	2 (13)	.33^+
Finished high school^1	7 (39)	4 (22)	7 (39)
Tertiary Qualifications	20 (44)	11 (24)	14 (31)
Stage
1	35 (47)	16 (22)	23 (31)	.18^+
2 or 3	4 (100)	0 (0)	0 (0)
Cancer Diagnosis
Breast Cancer	21 (51)	7 (17)	13 (32)	0.57
DCIS/LCIS	17 (46)	10 (27)	10 (27)
Time since diagnosis, years
Mean (SD)	7.77 (6.73)	5.88 (3.78)	8.21 (5.43)	0.43
Surgery Type
Mastectomy	23 (59)	13 (76)	19 (83)	.12^+
Lumpectomy	16 (41)	4 (25)	4 (17)
Breast Surgery Complications
Mean (SD)	2.28 (1.95)	2.65 (2.64)	4.35 (3.16)	.01*
Lymphoedema
Yes	4 (10)	2 (12)	8 (35)	.05*^+
No	35 (90)	15 (88)	15 (65)
Hormone Therapy
Yes	17 (44)	8 (47)	8 (35)	0.7
No	22 (56)	9 (53)	15 (65)
Psychotherapy
Yes	3 (8)	4 (24)	5 (22)	.16^+
No	36 (92)	13 (76)	18 (78)
Journal Writing
Yes	2 (5)	3 (18)	4 (17)	.22^+
No	37 (95)	14 (82)	19 (83)

* p<.05 ⁺ Fisher’s Exact utilised ¹ High school or equivalent.

Figure 2. Changes in self-compassionate attitude over time by condition using ITT analysis.

Table 2. Efficacy of treatment at post intervention using ITT analysis.

	MyCB combined (n = 56)	EW (n = 23)	Main Effect Time	Main Effect Group	Group × Time Interaction
	M (SD)	M (SD)	p/95% CI	p/95% CI	F	p/95% CI
Self-Compassionate attitude
Baseline	30.60 (9.10)	28.87 (7.35)	.55 (−3.84, 0.82)	.04 (−9.48, −1.74)	9.11	<.01* (1.30, 6.46)
Post Intervention	32.92 (9.69)	27.32 (7.67)
Positive Affect
Baseline	32.45 (12.19)	31.05 (9.94)	.88 (−3.49, 1.28)	.33 (−8.62, 2.04)	.86	.36 (−2.20, 5.99)
Post Intervention	33.55 (13.28)	30.26 (10.53)
Negative Affect
Baseline	16.48 (8.63)	16.83 (7.04)	.49 (−0.74, 2.61)	.64 (−2.53, 5.00)	.38	.54 (−3.75, 1.98)
Post Intervention	15.55 (9.39)	16.78 (7.44)

Note: Estimated marginal means and standard deviations reported. Controlling for age, Lymphoedema status and total complications reported at baseline.* p<.05.

Table 3. Efficacy of treatment at 1-month follow-up using ITT analysis.

	MyCB (n = 39)	MyCB + M (n = 17)	EW (n = 23)	Main effect time	Main effect group	Group × Time interaction
	M (SD)	M (SD)	M (SD)	p/95% CI	p/95% CI^a	F	p/95% CI^a
Body Image Distress
Baseline	12.07 (8.62)	10.65 (7.67)	13.57 (7.30)	.02* (0.61, 11.39)	.83 (−5.27, 4.74) (−5.24, 3.91)	2.25	.12 (0.14, 6.25) (−0.96, 5.13)
1-month follow-up	10.33 (9.87)	10.65 (7.67)	10.72 (8.00)
Body Image Appreciation
Baseline	3.33 (8.74)	3.79 (0.78)	3.18 (0.77)	.38 (−0.56, 0.48)	.05 (−0.96, 0.30) (−1.12, 0.11)	.72	.49 (−0.94, 0.39) (−0.61, 0.70)
1-month follow-up	3.32 (1.31)	3.82 (1.03)	3.49 (0.96)
Self-Compassion (trait)
Baseline	39.78 (10.80)	40.47 (9.55)	36.92 (9.22)	.04* (−7.67, −0.22)	.29 (−11.95, 1.08) (−10.97, 1.15)	1.73	.19 (−2.86, 6.62) (−0.49, 8.94)
1-month follow-up	39.50 (13.1)	44.42 (10.88)	38.98 (10.33)
Depression
Baseline	3.43 (4.80)	2.95 (4.25)	3.16 (0.41)	.96 (−1.35, 1.80)	.74 (−2.71, 3.05) (−1.53, 3.79)	.39	.68 (−1.96, 2.04) (−1.53, 3.79)
1-month follow-up	3.86 (5.74)	2.73 (4.82)	2.90 (4.56)
Anxiety
Baseline	2.49 (3.62)	3.97 (3.22)	2.58 (3.11)	.46 (−0.83, 2.24)	.38 (−3.16, 1.46) (−2.96, 1.41)	.27	.76 (−2.50, 1.43) (−2.65, 1.25)
1-month follow-up	2.49 (4.68)	3.26 (3.83)	2.41 (3.65)
Stress
Baseline	4.80 (5.06)	5.71 (4.04)	5.95 (3.88)	.94 (−1.96, 1.92)	.63 (−2.90, 2.91) (−3.39, 2.11)	.11	.90 (−2.24, 2.70) (−2.72, 2.18)
1-month follow-up	5.09 (5.93)	5.73 (4.74)	5.71 (4.56)

Note: Estimated marginal means and standard deviations reported. Controlling for age, Lymphoedema status and total complications reported at baseline.

* p<.05.

Figure 3. Changes in self-compassionate attitude over time by condition using sensitivity analysis.

Figure 4. Changes in positive affect over time by condition using sensitivity analysis.

Table 4. Efficacy of treatment at post intervention using sensitivity analysis.

	MyCB (combined) (n = 12)	EW (n = 11)	Main effect time	Main effect group	Group × Time interaction
	M (SD)	M (SD)	p	p	F	p
Self-Compassionate attitude
Baseline	31.76 (8.43)	30.50 (8.18)	.48 (−6.73, 1.27)	.15 (−14.48, 1.32)	12.10	<.01* (2.69, 10.58)
Post Intervention	35.76 (8.43)	27.86 (8.18)
Positive Affect
Baseline	36.08 (9.54)	33.52 (9.26)	.88 (−6.43, 0.76)	.14 (−15.30, 0.41)	4.43	<.05* (0.09, 10.48)
Post Intervention	38.92 (9.54)	31.07 (9.26)
Negative Affect
Baseline	14.98 (8.14)	16.68 (8.02)	.79 (−2.49, 5.66)	.32 (−2.35, 10.55)	.71	.41 (−8.29, 3.49)
Post Intervention	13.40 (8.14)	17.50 (8.02)

Note: Means and standard deviations reported. Controlling for age, Lymphoedema status and total complications reported at baseline.

* p<.05.

Figure 5. Changes in trait self-compassion over time by condition using sensitivity analysis.

Figure 6. Changes in anxiety over time by condition using sensitivity analysis.

Table 5. Efficacy of treatment at 1-month follow-up using sensitivity analysis.

	MyCB (n = 8)	MyCB + M (n = 4)	EW (n = 11)	Main Effect Time	Main Effect Group	Group x Time Interaction
	M (SD)	M (SD)	M	p/95% CI	p/95% CI^a	F	p/95% CI^a
Body Image Distress
Baseline	10.99 (7.44)	11.42 (6.19)	14.56 (7.35)	<.01* (1.97, 3.97)	.74 (−7.30, 8.44) (−8.26, 6.91)	1.69	.21 (−1.11, 5.84) (−3.39, 3.89)
1-month F/U	9.75 (7.44)	10.42 (6.19)	10.99 (7.35)
Body Appreciation
Baseline	3.48 (.64)	3.98 (.53)	3.37 (.63)	.13 (−0.42, 0.26)	.20 (−1.21, 0.151) (−1.11, 0.21)	.08	.92 (−0.48, 0.32) (−0.47, 0.37)
1-month F/U	3.61 (.64)	4.06 (.53)	3.53 (.63)
Trait Self-Compassion
Baseline	39.99^1 (10.89)	38.64^2 (9.06)	39.75^1,2 (3.25)	<.05* (−13.13, −1.87)	.83 (−16.13, 6.99) (−18.81, 3.52)	3.65	.04* (0.90, 12.26) (2.10, 15.90)
1-month F/U	38.48 (10.89)	46.14 (9.06)	41.57 (3.25)
Depression
Baseline	2.26 (4.13)	3.99 (3.42)	2.80 (4.09)	.76 (−0.99, 2.99)	.88 (−4.48, 4.27) (−4.46, 3.99)	.82	.45 (−3.41, 1.23) (−3.93, 0.93)
1-month F/U	2.76 (4.13)	2.99 (3.42)	2.89 (4.09)
Anxiety
Baseline	1.44 ^1 (3.20)	6.24^2 (2.66)	1.75^1 (3.32)	.02* (1.71, 5.29)	.17 (−4.37, 2.40) (−6.32, 1.93)	8.12	<.01* (−5.59, −1.41) (−6.32, −1.93)
1-month F/U	2.07 (3.20)	2.74 (2.66)	1.75 (3.32)
Stress
Baseline	5.16 (4.44)	7.04 (3.73)	5.67 (4.39)	.36 (−0.87, 5.37)	.92 (−3.64, 5.78) (−4.08, 5.07)	1.05	.37 (−6.08, 1.21) (−6.20, 1.45)
1-month F/U	5.28 (4.44)	4.77 (3.73)	5.86 (4.39)

Note: Adjusted means and standard deviations reported. Controlling for age, lymphoedema status and total complications reported at baseline.

^aConfidence intervals are reported for contrasts: EW vs. MyCB + M, MyCB vs. MyCB + M

^1,2 Denotes contrasts conducted following significant group x time interaction: same number indicates no significant difference, and different numbers indicate significant difference. * p<.05.

Table 6. Characteristics of participants that completed writing at baseline and adhered to MyCB Protocol, presented as Mean (SD) or number (%) of participants.

Characteristics	Completed writing (all groups) (n = 79)			MyCB (combined) (n = 56)
	Discontinued (n = 39)	Remained (n = 40)	p	Non Adherers (n = 31)	Adherers (n = 25)	p
Demographic
Age, years	54.41 (12.26)	61.93 (9.51)	<.01*	54.58 (12.52)	63.48 (10.28)	<.01*
Resides in Australia^a	26 (45.61)	31 (54.39)	0.42	20 (51.28)	19 (48.72)	.73^+
Partnered^a	32 (51.61)	30 (48.39)	0.45	24 (54.55)	20 (45.45)	0.82
Employed^a	21 (52.50)	19 (47.50)	0.57	17 (62.96)	10 (37.04)	0.27
Tertiary Education^a	22(49)	23(51)	0.88	18(58)	13(42)	0.77
Cancer Diagnosis^a
Breast Cancer	20 (48.78)	21 (51.22)	0.82	16 (57.14)	12 (42.86)	0.91
DCIS /LCIS	19 (51.35)	18 (48.65)		15 (55.56)	12 (44.44)
Stage (1)	35 (47)	39 (53)	.65^+	29 (56.86)	22 (43.14)	.59^+
Time since diagnosis, years	6.35 (4.06)	8.61 (7.03)	.07^	5.89 (4.03)	8.82 (7.6)	.07^
Surgery Type
Mastectomy^a	22 (40)	33 (60)	0.15	16 (44.44)	20 (55.56)	0.47
Lumpectomy^a	17 (70.81)	7 (29.17)	0.06	15 (75)	5 (25)	<.05*
Breast Surgery Complications	2.92 (2.41)	3 (2.85)	.90^	2.87 (2.48)	1.8 (1.53)	.04*^
Lymphoedema^a	6 (42.80)	8 (57.14)	.59^+	27 (54)	23 (46)	.44^+
Hormone Therapy^a	15 (45)	18 (54)	0.56	13 (52)	12 (48)	0.65
Psychotherapy^a	6 (50)	6 (50)	.60^+	27 (55)	22 (45)	.62^+
Journal Writing^a	1 (11)	8 (89)	.03^+	1 (20)	4 (80)	.16^+
Psychological
Body Image Distress	12.36 (9.38)	10.05 (8.04)	.22^	11.94 (.10)	7.32 (6.69)	.03*^
Body Image App	3.26 (.89)	3.68 (.74)	.03*	3.33 (.94)	3.92 (.61)	<.01*
Trait Self-Compassion	36.92 (8.84)	41.40 (9.18)	.03*	29.97 (7.95)	42.48 (7.11)	<.05*
State Self-Compassion	28.95 (7.78)	32.63 (6.40)	.03*	38.07 (8.56)	33.68 (5.99)	0.06
Positive Affect	31.00 (9.75)	32.93 (7.76)	0.33	31.52 (10.32)	33.88 (7.1)	.34^
Negative Affect	17.12 (7.43)	14.60 (6.02)	&lt;01*^	17.58 (7.70)	13.4 (4.2)	<.01*^
Depression	4.21 (4.60)	2.45 (3.08)	.02*^	4.23 (4.68)	1.96 (2.52)	.02*^
Anxiety	2.82 (3.44)	2.28 (2.83)	.53^	2.68 (3.35)	2.16 (2.82)	.52^
Stress	6.36 (4.26)	4.35 (3.63)	.08^	5.74 (4.06)	3.93 (3.72)	.06^

^a Reflects the number and percentage of participants answering ‘yes’ to this category.

* p < 0.05.

^ Transformed data utilised.

⁺ Fisher’s Exact utilised.

Table 7. Evaluation questions and responses.

Questions	MyCB* (n = 19)	Meditation (n = 8)
Number of participants that ‘somewhat’ to ‘strongly’ agreed with the following statements
This writing activity/meditation was appealing to me	15 (79%)	6 (75)
I felt comfortable doing the writing activity / listening to the meditation	14 (74%)	4 (50)
I found the writing / meditation instructions easy to understand	15 (79%)	7 (88)
I would be happy to do the writing activity / meditation again	13 (67%)	5 (63)

* Includes MyCB and MyCB + M participants