The Effectiveness of Self-Compassion Training: a field Trial

, Pages: 15-20 Academic Journals Global Journal of Medicine Researches and Studies www.academicjournalscenter.org ISSN 2345-6094 The Effectiveness of Self-Compassion Training: a field Trial Esmael Sarikhani Khorami *1, Mahin Moeini 2, Amir Ghamarani 3 1. Master's Degree Nursing Student, Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran 2. Assistant Professor, faculty member of Nursing and Midwifery school and the leading author of the article, Research Center of Nursing and Midwifery, Department of Adult Health Nursing, Isfahan University of Medical Sciences, Isfahan, Iran 3. Assistant Professor, faculty member of Education and Psychology school, Research Center of positive psychology and happiness, Department of Psychology and education of children with special needs, Isfahan University of Medical Sciences, Isfahan, Iran * Corresponding Author: E-mail: Sarikhani.e@gmail.com A R T I C L E I N F O Keywords: Self-compassion Students Nursing students Iran A B S T R A C T Objectives Considering the importance of introducing new methods of improving selfcompassion and compassion to the others in nursing students, this study intends to evaluate the effect of self-compassion training on nursing students. Methods This is a field trial study in which 52 nursing interns from Isfahan University of Medical Sciences were selected using convenience sampling method and divided in two experimental and control groups. The sampling was done during two phases: before and after the intervention. The intervention consisted of eight sessions over eight weeks of self-compassion training. The data were collected using the self-compassion standard questionnaire with 26 questions before and after the intervention. Data were then analyzed by the SPSS18 software and independent and paired T-tests, and also Chi-square and Mann-Whitney tests. Results The results obtained from the independent t-test showed that the mean score of selfcompassion and its components in the experimental group was significantly increased compared to the control group (p<0/001). Comparing the groups, the mean overall score difference of self-compassion and its components had also a statistically significant change after the intervention (p<0/001). Conclusion Self-compassion training program, leads to improving nursing students' selfcompassion. As it seems, this method can be used as an important training course in order to improve compassion of nursing students to themselves and the others. 2014 Global Journal of Medicine Researches and Studies. All rights reserved for Academic Journals Center. INTRODUCTION In recent decades the interest of experts to emphasize the positive aspects of psychological variables, have been growing. One of the positive and important elements that has attracted the attention of scholars in this field, is self-compassion and its' training. Self-compassion is defined as the ability to cope with pain and suffering and feeling full help to solve your problem. It includes care and compassion toward self in face of difficulties or cognitive impairment [1]. Self-compassion is a healthy form of susceptibility which shows the acceptance of unfavorable aspects of life and it was first conceptualized by Neff (2003) [2]. Selfcompassion is a form of compassion which is directed toward the individual [3]. This structure consists of three components that interact with each other; self-kindness, common human being awareness and mindfulness [2]. Self-kindness means having a nonjudgmental attitude of self. In such a case, the person is able to have an attitude with gentleness and kindness toward himself, even in face of failures, and understands that all human beings fail and experience the pain. Having such characteristics enables individuals to focus on the ways that reach to happiness and well-being, doing away with pain and suffering, and achieving enlightenment, instead of focusing on ways leading to failure [4]. Another component of self-compassion is common human

being awareness, meaning that when a person experiences sorrows and joys of life, is aware that such difficulties is the same as other people's experience. When someone fails, reminds that anyone may fail in life and failure is part of the normal human experience, instead of comparing himself with others in self-criticism [3]. Eventually, mindfulness is a kind of perceptual awareness that allows the individual to accept and go along painful emotions without being captured by them [3]. Martin (1997) expresses mindfulness as a state of psychological release that is a result from peace of mind and confidence without being attached to a particular point of view [5]. In self-compassion, painful and uncomfortable feelings are placed in the individual's consciousness with kindness, insight and a sense of common human being rather than to be avoided, in which case negative feelings will change to a more positive emotional state [6]. According to Allen & Leary (2010) self-compassion is a coping technique that helps people to face their negative life events [7]. Studies also show that the positive components of selfcompassion are related to psychological abilities such as happiness, optimism, positive affection, coping skills, better communications, feeling less failure and also psychological well-being [8, 9, 10]. The importance of self-compassion for nursing students has been expressed a lot in caring theories. Self-compassion can be taught to nursing students in order to apply it for the patients. However self-compassion is not a kind of interfere running by nurses, but it is an internal phenomenon that affects nursing performance and feedback (clinical practice) for the patients [11]. On the other hand, researches indicate a relationship between self-compassion and self-efficacy [12]. Since the self-compassion is a new and fresh concept, it can grow in various fields of researches and interventions. It seems that self-compassion has benefits for education and schooling as well. Self-compassion is a human positive force that can create positive qualities such as kindness, compassion, equanimity and sense of coherence with the others [13]. Learning such features for a nursing student is a major part of his future career, which enables him to enter this profession. In a situation where if a nursing student cannot be compassionate to himself, he cannot have a true compassion for the others [4]. Furthermore, according to various studies, unnecessary stressful factors such as lacking of equipment and medicine, non-standard devices, inappropriate physical environment of hospital, the probability of disease transmission, the absence of timely physician and inappropriate communications with workmates are very common which causes fatigue and lack of coordination, loss of sense of cooperation and the difficulty in making the right decisions so that nurses are away from their main task which is taking care of patients [14]. On the other hand, caring patients with injuries, pain and suffering, affects nurses' health and exhausts them to be compassionate to the patients. Even in Tam's study in 2004, nurses reported more anxiety than the other health care workers during the SARS epidemic [16]. Even nurses who did not work in sectors with patients suffering from SARS, reported more anxiety and more related physical symptoms than the other health care workers. [17]. It seems that learning the techniques of self-compassion could help nurses in controlling stressors of job and environment. Moreover, the number of articles associated with this structure is very limited in Iran and almost no global studies of this structure has been done on students and nursing community. Accordingly, finding new methods of promoting positive psychological aspects of nursing and subsequently improving the quality of care can be the effects of this research. Therefore, in this study we tried to evaluate the effectiveness of self-compassion training on nursing students of Isfahan University of medical sciences, as the first group of medical community, on whom this structure is studied. MATERIALS AND METHODS This study is a field trial that samples with convenience sampling among all nursing students who were able to obtain the course of internship in 7 and 8 semester were collected. Inclusion criteria included: no history of training of self-compassion, verbal and written consent to participate in research and lack of mental health problems was known. Exclusion criteria included the willingness of students to withdraw from the study, the non-completion or partial completion of the questionnaire and the absence of more than one sessions intervention. Then samples randomly and convenience sampling, were divided into 2 groups for the draw. This means that the names of students were written on a paper and assigned a number to each student. Even numbers in the intervention group and odd numbers in the control group were divided. Finally, 26 students Semester 7 and 8, in the intervention group and 26 students in the control group were divided. Pre-test was taken from 2 experimental and control groups simultaneously before starting educational program at the school of nursing by using a standardized questionnaire selfefficacy of clinical performance in nursing students from Cheraghi s framework. In experimental group classes with lectures and Q & A along with assignments to samples for 8 weeks (each week a 1/5 hour session) at the faculty of nursing in University of Medical Sciences with the approval of the supervisor and the supervised psychologist counselor that in this concept had the necessary background held. Post Test was given one month after the educational program from experimental and control groups at the same time. Students in the control group were put together in a separate class, during 2 sessions with presence and management the sessions by the researcher, about clinical education problems were discussed with each other. But did not receive any interventions in connection with self-compassion. Data collection tools include self-compassion questionnaire that was built in 2003 by Neff, a self-report scale has 26 self-report items and consists of six sub-scales (self-kindness (5 items, 5-12-19-23-26), common humanity(4 items, 3-7-10-15), mindfulness (4 items, 9-14-17-22), self-judgment (5 items, 1-8-11-16-21), isolation(4 items, 4-13-18-25), and over-identification(4 items, 2-6- 20-24)). Previous studies have shown this six subscales have high internal consistency. Cronbach's alpha coefficient of the questionnaire in the Iranian version was in the range of 0.61 for over-identification subscale to 0.89 for mindfulness subscale. To calculate the total score, the scores of statements of isolation, over-identification and self-judgment reversed and then gathered with positive subscale were also collected; the six subscale scores as well (including reverse scores) created total score of selfcompassion. 16

Analysis of the findings, using descriptive and inferential statistics such as independent & paired t-test, Mann-Whitney and chisquare tests with using SPSS software version 18 were performed. FINDINGS The results of this study showed that variables such as age, grade, gender and parental education in both experimental and control groups (Table 1 and 2) were approximately identical. About 80 percent of fathers and 90 percent of mothers, had diploma or lower educations. The average age of students was about 22 years old and the number of female participants was more. The independent T-test showed (Table 3) that the average score of self-compassion and its' fields in both groups before the intervention, had no significant difference (05/0 p>). It also indicated (Table 4) that the overall mean score of compassion in groups, before and one month after intervention had a statistically significant difference (001/0 p <). The results also showed a significant increase of the overall mean score change in both groups before and after one month of intervention (001/0 p <) (Table 5). Variables Experimental group Control group Independent t test Mean S.D Mean S.D t p Age(Year) 22.35 1.23 22.46 0.58 0.18 0.66 GPA education 15.77 0.93 16.25 1.25 2.42 0.12 Table 1: Average age, total GPA in experimental and control groups Sex Experimental group Control group Number Percentage Number Percentage Male 11 42.3 11 42.3 Female 15 57.7 15 57.7 Total 26 100 26 100 Table 2: (chi-square test) comparison the frequency of sex of the students in the experimental and control groups Self-Compassion and its components (pre- Control group intervention) Experimental group (preintervention) Independent t test Mean S.D Mean S.D t p Total score of Self- Compassion 52 12.7 53.6 10.3 0.48 0.63 Self-kindness 53.7 13.5 56.7 16.4 0.73 0.46 Self-judgment 58.8 18.8 56.7 15.3 0.44 0.65 Common humanity 60.3 18.6 62 17.1 0.33 0.73 Mindfulness 62 16.8 63.8 14.8 0.41 0.68 Isolation 50.2 12.6 49.8 17.8 0.11 0.91 Over-identified 54.3 19.8 54.2 17.3 0.03 0.97 17

Table 3: Comparison total score of self-compassion and its components in the experimental and control groups before intervention Self-Compassion and its components Experimental group (one month post-intervention) Control group (one month post-intervention) Independent t test Mean S.D Mean S.D t p Total score of Self- Compassion 67.3 10.3 51.8 6.5 6.66 > 0.001 Self-kindness 70 11.9 53.8 17.7 3.81 0.001 Self-judgment 33.6 18.8 57.1 11.8 5.36 > 0.001 Common humanity 75.7 18.6 60.2 17.1 3.12 0.003 Mindfulness 73.7 13 62 14.4 3.05 0.004 Isolation 45 12.6 52.3 13.3 2.01 0.04 Over-identified 37.2 15.6 59.4 12.5 5.6 > 0.001 Table 4: Comparison of Self-Compassion score and its components in the experimental and control group one month after the.intervention Self-Compassion and its components Experimental group (one month post-intervention) Control group (one month post-intervention) Independent t test Mean S.D Mean S.D t P Total score of Self- Compassion 14.9 12.6 2.4 15.4 4.43 > 0.001 Self-kindness 16 18.9 2.8 25.5 3.03 0.004 Self-judgment -24.8 20.7-0.4 13.5 5.17 > 0.001 Common humanity 15.1 20.5 1.8 19.7 3.02 0.004 Mindfulness 11.5 20.2 1.8 17.8 2.52 0.015 Isolation -5.1 17.2-2.6 20.8 1.45 0.014 Over-identified -16.6 22.8-5.2 19.2 3.73 0.001 Table 5: mean change in total score of Self-Compassion and its components in the experimental and control groups one month after the intervention than before the intervention DISCUSSION AND CONCLUSION The results of the study after one month of intervention, demonstrated that self-compassion training program increased the overall score of self-compassion and its fields in nursing students of the experimental group significantly (001 / 0p <). However, there was not a significant change in the overall score of the control group (05 / 0p>). 18

Self-Compassion in different fields of study was obtained with average score of 52 (SD = 7/12 ±), which is the overall mean and compassion to different fields of study Basharpoor was pretty average. The results of this study confirm the results Albertson et al in 2014 in America as " self-compassion and body dissatisfaction in women: a randomized controlled trial of a brief meditation intervention" was carried out overall score of compassion (05/0> p) after the intervention in the control group had no significant difference [19]. The field judge in the control group before and after the study is also to intervention in the case. Different samples to researchers, this difference may be due to differences in the experiences acquired by the study subjects. In this study, the average age of students is 22 years while the average age of the patients in the study Hofmann more than 50 years and are registered nurses with nursing qualifications. However, Basharpoor study titled "psychometric properties of the Persian version of its sympathy to the students", the highest mean scores of kindness to your domain. However, in this case also could be a result of different samples relative to this experiment. Results of empirical studies confirm the results of this study showed that with the increase of self-compassion through mindfulness-based interventions in different groups, can increase positive results on students' clinical performance have compassion and reform. 85 percent improvement in their ability to understand their illness and treatment process reported [22]. As a result, evidence suggests that medical students may feel more effective when more of his kind have.it may be noted here that almost all the studies surveyed in this study self-compassion structures introduced as a positive structures and the researchers observed contradictory in relation to the structures not found. Also in terms of selfcompassion researcher training programs in various studies lowering effects of depression, anxiety and stress and increasing impact on happiness, optimism, positive affect, coping skills, better communication with others and feelings of failure on different groups have shown less able to the impact of these factors on students, compassion positive effects on improving nursing students and nursing process have improved. CONCLUSION Self-compassion training program for nursing students improved their compassion. So it seems that putting this method in nursing education programs, can play an important role in improving their compassion to patients. LIMITATIONS As an example of limitations, we can mention the students receiving information from other sources in the control group, especially from other fellow students trained, which could affect the results of the study and researchers were not able to control it. SUGGESTIONS Limited time for such intervention as a student thesis, led the short time allocated to track students after the intervention. For this purpose, in order to generalize the findings, we suggest future studies with longer follow-up period in this field to survey the long-term sustainability of self-compassion training. ACKNOWLEDGEMENT This article is taken from a student thesis research project with code no. (394 355) and ethics code (IR.MUI.REC.1394.3.557) approved by the Research Department of Nursing and Midwifery, Isfahan University of Medical Sciences. Thereby we sincerely appreciate all senior nursing students and faculty of nursing and midwifery and its authorities. ETHICAL APPROVAL Ethical considerations in this research are informed and the right to refuse to continue of research and leaking their identity was emphasized. This study is no conflict of interest and financial costs which have been prepared by the Research Department of Nursing and Midwifery of Isfahan University of Medical Sciences. 19

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