Compassion cultivation training may decrease caregivers’ psychological distress

Compassion cultivation training effectively decreased psychological distress among caregivers of individuals with mental illness, according to results of a randomized clinical trial conducted in Denmark and published in JAMA Network Open.

“Compassion training has been found to be associated with decreased psychological distress and increased overall well-being,” Nanja Holland Hansen, MCounseling, of the department of clinical medicine at the Danish Center for Mindfulness, and colleagues wrote. “However, evidence-based programs for the effectiveness in the prevention of psychological distress for informal caregivers of people with mental illness are lacking. Two systematic reviews demonstrated that compassion training may promote mental health. However, the compassion interventions varied from 7 minutes to 8 weeks, with very few of the interventions being manualized, and not all included studies were randomized clinical trials.”

In the current study, the investigators aimed to assess whether a compassion cultivation training program decreased caregiver psychological distress. They conducted the waitlist-controlled randomized clinical trial in two different Denmark community settings. Diagnosed and untreated mental illness, addiction, meditation practice or current psychotherapeutic treatment served as exclusion criteria for the caregivers. Hansen and colleagues randomly assigned participants 1:1 to an 8-week compassion cultivation training course or waitlist control and used block randomization, with 40 participants in each block. They included 161 participants in the study, of whom 79 received the intervention while 82 comprised the waitlist control group. Reduction in psychological distress according to the Depression, Anxiety, Stress Scale (DASS) served as the main outcome. The researchers collected baseline, postintervention and 3- and 6-month follow-up measurements.

Results showed baseline DASS scores for the intervention vs. control groups were 10.89 vs. 10.8 for depression, 6.89 vs. 6.68 for anxiety and 14.96 vs. 15.77 for stress. The compassion cultivation training group exhibited statistically significant improvement in the primary outcome in mean change from baseline vs. the control group at postintervention, for an adjusted mean difference of –4.16 for depression, –2.24 for anxiety, –4.2 for stress. They also exhibited improvement at the 3-month follow-up, for an adjusted mean difference of –3.78 for depression, –2.5 for anxiety and –3.76 for stress, as well as at the 6-month follow-up, for an adjusted mean difference of –4.24 for depression, –2.12 for anxiety and –3.79 for stress.

“Policy makers and health care professionals have few options in offering caregiver’s evidence-based interventions that help improve their mental health,” Hansen and colleagues wrote. “Future research should replicate findings and compare the intervention with an active control. Furthermore, a potential mediating effect of the [compassion cultivation training] intervention on compassion for self and mindfulness on psychological distress should be explored and future research should investigate whether there is a difference in the effect depending on caregiver status, type of mental disorder and length of intervention.”