Effects of Attachment-Based Compassion Therapy (ABCT) on Self-compassion and Attachment Style in Healthy People

Abstract

Attachment-based compassion therapy (ABCT) is a new protocol of compassion based on attachment theory. The aim of this study was to assess the efficacy of this protocol for improving self-compassion in a healthy population and determine whether improvements in self-compassion mediate changes towards a more secure attachment style. The study consisted of a non-randomized controlled trial with an intervention group (ABCT) and a waiting list control group. In addition to pre- and post-intervention assessments, a 6-month follow-up assessment was included. Participants were healthy adults attending ABCT courses who self-rated as not having any psychological disorders and self-reported as not receiving any form of psychiatric treatment. Compared to the control condition, ABCT was significantly more effective for improving self-compassion as evidenced by changes on all subscales on the Self-Compassion Scale (SCS), except isolation. Effect sizes were in the moderate to large range and correlated with the number of sessions received. ABCT also led to improvements across all subscales of the Five Facets of Mindfulness Questionnaire (FFMQ), except describing. ABCT decreased psychological disturbance assessed using the General Health Questionnaire (GHQ-28) and decreased experiential avoidance assessed using the Acceptance and Action Questionnaire (AAQ-II). Furthermore, ABCT led to significant reductions in levels of anxiety and avoidance. Secure attachment style significantly increased in the ABCT group and was mediated by changes in self-compassion. In summary, ABCT may be an effective intervention for improving self-compassion and attachment style in healthy adults in the general populations.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Alonso-Arbiol, I. (2000). Atxkimendu insegurua eta genero rolak pertsonarteko mendekotasunaren korrelatu gisa. Doctoral Dissertation. Basque Country University. Sebastián.

  2. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.

    Google Scholar 

  3. Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and non meditating samples. Assessment, 15, 329–342.

    Google Scholar 

  4. Banse, R. (2004). Adult attachment and marital satisfaction: evidence for dyadic configuration effects. Journal of Social and Personal Relationships, 21(2), 273–282.

    Google Scholar 

  5. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: a test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.

    PubMed  Google Scholar 

  6. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behaviour Therapy, 42(4), 676–688.

    Google Scholar 

  7. Bridges, K. W., & Goldberg, D. P. (1986). The validation of the GHQ-28 and the use of the MMSE in neurological in-patients. The British Journal of Psychiatry, 148(5), 548–553.

    PubMed  Google Scholar 

  8. Carlson, K. D., & Schmidt, F. L. (1999). Impact of experimental design on effect size: Findings from the research literature on training. Journal of Applied Psychology, 84(6), 851–862.

    Google Scholar 

  9. Cebolla, A., García-Palacios, A., Soler, J., Guillen, V., Baños, R., & Botella, C. (2012). Psychometric properties of the Spanish validation of the five facets of mindfulness questionnaire (FFMQ). The European Journal of Psychiatry, 26(2), 118–126.

    Google Scholar 

  10. Chapin, H. L., Darnall, B. D., Seppala, E. M., Doty, J. R., Hah, J. M., & Mackey, S. C. (2014). Pilot study of a compassion meditation intervention in chronic pain. Journal of Compassionate Health Care, 1(1), 4.

    PubMed  PubMed Central  Google Scholar 

  11. Demarzo, M. M., Cebolla, A., & García-Campayo, J. (2015). The implementation of mindfulness in healthcare systems: a theoretical analysis. General Hospital Psychiatry, 37(2), 166–171.

    PubMed  Google Scholar 

  12. Egbewale, B. E., Lewis, M., & Sim, J. (2014). Bias, precision and statistical power of analysis of covariance in the analysis of randomized trials with baseline imbalance: a simulation study. BMC Medical Research Methodology, 14(1), 49.

    PubMed  PubMed Central  Google Scholar 

  13. Fearon, R. M. P., & Roisman, G. I. (2017). Attachment theory: progress and future directions. Current Opinion in Psychology, 15, 131–136.

    PubMed  Google Scholar 

  14. Feise, R. J. (2002). Do multiple outcome measures require p-value adjustment? BMC Medical Research Methodology, 2(1), 8.

    PubMed  PubMed Central  Google Scholar 

  15. Feliu-Soler, A., Pascual, J. C., Elices, M., Martín-Blanco, A., Carmona, C., Cebolla, A., et al. (2017). Fostering self-compassion and loving-kindness in patients with borderline personality disorder: a randomized pilot study. Clinical Psychology & Psychotherapy, 24(1), 278–286.

    Google Scholar 

  16. Fiorini, H.J. (2006). Theory and technique of psychotherapy. Buenos Aires: Nueva Visión.

  17. Fredrickson, B. L., Cohn, M., Coffey, K. A., Pek, J., & Finkel, S. A. (2008). Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95, 1045–1062.

    PubMed  PubMed Central  Google Scholar 

  18. Galante, J., Galante, I., Bekkers, M. J., & Gallacher, J. (2014). Effect of kindness-based meditation on health and well-being: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 82(6), 1101.

    PubMed  Google Scholar 

  19. García-Campayo, J., & Demarzo, M. (2015). Mindfulness y compasión: la nueva revolución. Barcelona: Siglantana.

    Google Scholar 

  20. Garcia-Campayo, J., Navarro-Gil, M., Andrés, E., Montero-Marin, J., López-Artal, L., & Demarzo, M. M. P. (2014). Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS). Health and Quality of Life Outcomes, 12(1), 4.

    PubMed  PubMed Central  Google Scholar 

  21. García-Campayo, J., Cebolla, A., & Demarzo, M. M. (2016a). La ciencia de la compasión: más allá del mindfulness. Madrid: Alianza Editorial.

    Google Scholar 

  22. García-Campayo, J., Navarro-Gil, M., & Demarzo, M. (2016b). Attachment-based compassion therapy. Mindfulness & Compassion, (2), 68–74.

  23. García-Campayo, J., Demarzo, M., Shonin, E., & Van Gordon, W. (2017). How do cultural factors influence the teaching and practice of mindfulness and compassion in Latin countries? Frontiers in Psychology, 8, 1161.

    PubMed  PubMed Central  Google Scholar 

  24. Gilbert, P. (2014). The origins and nature of compassion focused therapy. The British Journal of Clinical Psychology, 53(1), 6–41.

    PubMed  Google Scholar 

  25. Gilbert, P., McEwan, K., Catarino, F., Baião, R., & Palmeira, L. (2014). Fears of happiness and compassion in relationship with depression, alexithymia, and attachment security in a depressed sample. British Journal of Clinical Psychology, 53, 228–244.

    PubMed  Google Scholar 

  26. Goldberg, S. B., Wielgosz, J., Dahl, C., Schuyler, B., MacCoon, D. S., Rosenkranz, M., et al. (2016). Does the Five Facet Mindfulness Questionnaire measure what we think it does? Construct validity evidence from an active controlled randomized clinical trial. Psychological Assessment, 28(8), 1009.

    PubMed  Google Scholar 

  27. Goodall, K., Trejnowska, A., & Darling, S. (2012). The relationship between dispositional mindfulness, attachment security and emotion regulation. Personality and Individual Differences, 52, 622–626.

    Google Scholar 

  28. Griffin, D. W., & Bartholomew, K. (1994a). The metaphysics of measurement: the case of adult attachment. In K. Bartholomew y D. Perlman (Eds.), Advances in personal relationships (Vol. 5: Adult attachment relationships, pp. 17-52). London: Jessica Kingsley.

  29. Griffin, D. W., & Bartholomew, K. (1994b). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67(3), 430–445.

    Google Scholar 

  30. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy. An experiential approach to behavior change. New York: Guilford.

    Google Scholar 

  31. Jazaieri, H., Jinpa, G. T., McGonigal, K., Rosenberg, E. L., Finkelstein, J., Simon- Thomas, E., & Goldin, P. R. (2013). Enhancing compassion: a randomized controlled trial of a compassion cultivation training program. Journal of Happiness Studies, 14(4), 1113–1126.

    Google Scholar 

  32. Jazaieri, H., McGonigal, K. M., Jinpa, T. L., Doty, J. R., Gross, J. J., & Goldin, P. R. (2014). A randomized controlled trial of compassion cultivation training: effects on mindfulness, affect, and emotion regulation. Motivation and Emotion, 38, 23–35.

    Google Scholar 

  33. Jazaieri, H., Lee, I. A., McGonigal, K., Jinpa, T., Doty, T., Gross, J. R., & Golding, P. R. (2015). A wandering mind is a less caring mind: daily experience sampling during compassion meditation training. The Journal of Positive Psychology, (1, 1), 37–50.

  34. Jinpa, G. T. (2010). Compassion cultivation training (CCT): instructor’s manual (unpublished).

    Google Scholar 

  35. Krasuska, M., Millings, A., Lavda, A. C., & Thompson, A. R. (2017). Compassion focussed self-help for skin conditions in individuals with insecure attachment: a pilot evaluation of the acceptability and potential effectiveness. British Journal of Dermatology. https://doi.org/10.1111/bjd.15934

    PubMed  Google Scholar 

  36. Leak, G. K., & Parsons, C. J. (2001). The susceptibility of three attachment style measures to socially desirable responding. Social Behavior and Personality, 29, 21–30.

    Google Scholar 

  37. Leaviss, J., & Uttley, L. (2015). Psychotherapeutic benefits of compassion-focused therapy: an early systematic review. Psychological Medicine, 45, 927–945.

    PubMed  Google Scholar 

  38. Lobo, A., Perez-Echeverria, M. J., Jimenez, A., & Sancho, M. A. (1988). Emotional disturbances in endocrine patients. Validity of the scaled version of the General Health Questionnaire (GHQ-28). The British Journal of Psychiatry, 152(6), 807–812.

    PubMed  Google Scholar 

  39. Lockhart, G., MacKinnon, D. P., & Ohlrich, V. (2011). Mediation analysis in psychosomatic medicine research. Psychosomatic Medicine, 73(1), 29–43.

    PubMed  Google Scholar 

  40. MacBeth, A., & Gumley, A. (2012). Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552.

    PubMed  Google Scholar 

  41. Mickelson, K. D., Kessler, R. C., & Shaver, P. R. (1997). Adult attachment in a nationally repre- sentative sample. Journal of Personality y Social Psychology, 73, 1092–1106.

    Google Scholar 

  42. Montero-Marin, J., Gaete, J., Demarzo, M., Rodero, B., Lopez, L. C., & García-Campayo, J. (2016). Self-criticism: a measure of uncompassionate behaviors toward the self, based on the negative components of the self-compassion scale. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2016.01281

  43. Montero-Marin, J., Navarro-Gil, M., Puebla-Guedea, M., Luciano, J. V., Van Gordon, W., Shonin, E., & Garcia-Campayo, J. (2018). Efficacy of ‘attachment-based compassion therapy’ (ABCT) in the treatment of fibromialgia: a randomized controlled trial. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2017.00307

  44. Morris, S. B. (2008). Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11(2), 364–386.

    Google Scholar 

  45. Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250.

    Google Scholar 

  46. Neff, K.D. (2012). Sé amable contigo mismo. El arte de la compasión hacia uno mismo. Barcelona. Onir.

  47. Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69, 28–44.

    PubMed  Google Scholar 

  48. Neff, K. D., Rude, S. S., & Kirkpatrick, K. (2007). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality, 41, 908–916.

    Google Scholar 

  49. Pace, T. W., Negi, L. T., Adame, D. D., Cole, S. P., Sivilli, T. I., Brown, T. D., et al. (2009). Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology, 34(1), 87–98.

    PubMed  Google Scholar 

  50. Pepping, C. A., O’Donovan, A., & Davis, P. J. (2014). The differential relationship between mindfulness and attachment in experienced and inexperienced meditators. Mindfulness, 5, 392–399.

    Google Scholar 

  51. Pepping, C. A., Davis, P. J., & O’Donovan, A. (2015). The association between state attachment security and state mindfulness. PLoS One, 10(3), e0116779.

    PubMed  PubMed Central  Google Scholar 

  52. Raque-Bogdan, T. L., Piontkowski, S., Hui, K., Ziemer, K. S., & Garriott, P. O. (2016). Self-compassion as a mediator between attachment anxiety and body appreciation: an exploratory model. Body Image, 19, 28–36.

    PubMed  Google Scholar 

  53. Ruiz, F. J., Langer Herrera, A. I., Luciano, C., Cangas, A. J., & Beltrán, I. (2013). Measuring experiential avoidance and psychological inflexibility: the Spanish version of the Acceptance and Action Questionnaire—II. Psicothema, 25(1), 123–129.

    PubMed  Google Scholar 

  54. Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: a systematic review. Mindfulness, 6, 1161–1180.

    Google Scholar 

  55. Shonin, E., Van Gordon, W., Garcia-Campayo, J., & Griffiths, M. D. (2017). Can compassion help cure health-related disorders? British Journal of General Practice, 67, 177–178.

    PubMed  Google Scholar 

  56. White, I. R., Horton, N. J., Carpenter, J., & Pocock, S. J. (2011). Strategy for intention to treat analysis in randomised trials with missing outcome data. British Medical Journal, 342, d40.

    PubMed  Google Scholar 

  57. Yárnoz-Yaben, S. (2010). Attachment style and adjustment to divorce. Spanish Journal of Psychology, 13, 210–219.

    PubMed  Google Scholar 

  58. Yárnoz-Yaben, S., & Comino, P. (2011). Evaluación del apego adulto: análisis de la convergencia entre diferentes instrumentos [Assessment of adult attachment: analysis of the convergence between different instruments]. Acción Psicológica, 8(2), 67–85.

    Google Scholar 

  59. Yárnoz-Yaben, S., Alonso-Arbiol, I., Plazaola, M., & Sainz de Murieta, L. M. (2001). Apego en adultos y percepción de los otros. Anales de Psicología, 17, 159–170.

    Google Scholar 

Download references

Funding

We appreciate the support provided by the Research Network on Preventative Activities and Health Promotion (RD06/0018/0017) and the Aragon Health Sciences Institute.

Author information

Affiliations

Authors

Contributions

MNG designed and executed the study and assisted with the writing of the manuscript. YLH designed and assisted with the writing of the manuscript. MMA executed the study and collaborated in the editing of the manuscript. WVG collaborated in the writing of the final manuscript. ES collaborated in the writing of the final manuscript. JMM developed the data analyses and assisted with the writing of the results and the manuscript. JGC designed and executed the study and collaborated in the writing of the final manuscript.

Corresponding author

Correspondence to Jesus Montero-Marin.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

The study was approved by the Aragon Ethical Committee (Spain). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee (Aragon Ethical Committee), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Navarro-Gil, M., Lopez-del-Hoyo, Y., Modrego-Alarcón, M. et al. Effects of Attachment-Based Compassion Therapy (ABCT) on Self-compassion and Attachment Style in Healthy People. Mindfulness 11, 51–62 (2020). https://doi.org/10.1007/s12671-018-0896-1

Download citation

Keywords

  • Compassion
  • Self-compassion
  • Attachment
  • Attachment-based compassion therapy
  • ABCT
  • Mindfulness