Effectiveness of Compassion-Therapy Training on Suicidal Thoughts of Female Adolescents

doi:10.21203/rs.3.rs-4663615/v1

The present research was conducted aiming at the effectiveness of compassion-therapy training on suicidal thoughts of adolescent girls. The present research methodology was an experiment with a pre-test, post-test design with a control group. The statistical population of the research included 33 female adolescent students from three second secondary schools in Khomein County in the academic year of 2022–2023, who had a history of self-harm and were referred to Education Counseling Center. Out of this number, 20 students were selected by simple random sampling method and randomly divided into two 10-individual groups. The experimental group and the control group were determined randomly. The suicidal ideation scale of Erich et al. (1991) was used to gather the data. Gilbert's (2021) self-compassion training intervention was implemented in 8 training sessions for 90 minutes during a month (twice a week). One-way analysis of covariance test was used to analyze the data. The findings indicated that compassion-therapy training has been influential on adolescent girls' suicidal thoughts and this training has explained 70% of the variance of the suicidal thoughts. Based on the findings of this research, it can be concluded that the self-compassion-focused treatment is an effective strategy to help reduce the suicidal thoughts of adolescent girls.

Compassion Treatment

Suicidal Thoughts

Female Adolescents

Adolescence is the period of transition from childhood to adulthood, and important behavior patterns, which can affect a person's life throughout her life, are formed in this period (1).

Changes in this period of development may cause certain problems. When adolescents cannot overcome crises and transformational challenges successfully, they will experience psychological distress and a significant disruption will emerge in the normal flow of daily life and cognitive and social emotional aspects, as a result of which their personality will be disordered (2).

The development and spread of psychological and social harms in societies, which go through a transitional state, is inevitable. Undoubtedly, Iran's society is currently in a period of transition from tradition to modernity, which is accompanied by special problems and difficulties and cultural and social harms. One of the most important social harms is suicide (3).

The anger expressed toward oneself does not refer to a single behavior, but rather addresses many diverse and complex behaviors broadly and may include talking about suicidal thoughts, intentionality, suicidal behaviors, suicidal attempts, or others. Many attempts have been made to identify the risk factors that lead to suicidal thoughts or attempts aiming at understanding and preventing suicide. However, suicide is still one of the major causes of death worldwide and its rate has not decreased and identifying the individuals, who have the most risk factors for suicide, is critical (4).

Almost one million people (one person every 41 seconds) die due to suicide every year according to the statistics published by the World Health Organization. In addition, the suicide rate has increased by 60% all over the world in the last 45 years (5).

The rate of suicide has been increasing during the last 50 years. Although the category of suicide has received more attention in developed countries, it has been neglected in developing countries and there are no statistics on suicide in more than half of the world's countries (6).

The importance of the suicide is due to the fact that the World Health Organization published the title "Suicide prevention is a global necessity" in 2014 and called the September 10 the World Suicide Prevention Day. Suicide has widespread consequences for human societies. As the technology advances and the virtual networks expand, we are witnessing the emergence of new causes and reasons for suicide that did not exist in previous researches or were less addressed due to the lack of development of virtual networks in the past years. Therefore, the diagnosis of treatment and education (instruction) and the factors affecting it are of special importance among adolescents; since it hinders their academic success and progress and prevents them from reaching a high level of progress.

Suicidal thoughts do not belong to a specific period of life, but it seems that adolescents show more fragility in moments of life when they face personal problems, and this is while they feel that there is no way back (7).

This concept includes a range of ambiguous thoughts about the possibility of ending the life to a complete suicide. In fact, suicidal thoughts are a concept that implies the occurrence of any self-destructive thoughts (8).

Suicidal thoughts are closely related to unconventional reactions such as drug use, running away from home, and conflict with others (9).

Reducing suicide attempts requires the use of long-term treatments and special treatment methods to solve specific skill deficits such as: emotion regulation, low tolerance for impulsivity, anger control and interpersonal assertiveness, as well as other long-term problems such as self-image and interpersonal relationship disorders. People with suicidal thoughts mostly refuse to communicate and attend in public and consider solitude more suitable for their circumstances; Such people cannot easily communicate with people in a state of compassion, self-compassion is not only not possible in this state, but its symptoms also increase. Gilbert proposed the theory of compassion-based therapy, whose main technique is to treat the

Compassionate mind, in 2000. Cognitive-behavioral therapy, social psychology, and commitment- and acceptance-based therapy are used in this model (10).

Self-compassion is a typical strategy among different types of emotion regulation strategies, in which it is not prevented from experiencing unpleasant and annoying emotions, but it is tried to accept the emotions in a kind and compassionate way; therefore, negative emotions change into positive emotions and the person finds a new way to cope (11).

Basic principles in compassion-focused therapy suggest that external soothing thoughts, factors, images, and behaviors must be internalized; In this case, the human mind calms down when faced with these internal factors as it reacts to external factors (12).

Additionally, people learn not to avoid their painful feelings and not to suppress them in compassion treatment, so they can recognize their experience and feel compassion for it in the first step (13).

Compassion-focused therapy also focuses on helping people understand that the human brain has evolved in a way that predisposes one to rumination, bias, negativity, and critical self-monitoring (14).

People learn to shift their attention from being ashamed of these problems to working with them compassionately in this treatment (15).

Researches have shown that the presence of self-compassion in humans has caused the reduction of mental disorders and suicidal thoughts (7).

Compared to other diseases and mental and physical disorders that have been subjected to numerous investigations, there are limited researches regarding suicidal thoughts of adolescents in the field of compassion-based treatment. Therefore, that the present research aims to answer the question, is compassion-based therapy training influential on adolescent girls' suicidal thoughts?

Ethics approval and consent to participate

The code of ethics IR.IAU.NAJAFABAD.REC.1402.158 has been registered for the present research.

Research Tool

1-Suicidal Ideation Scale: This questionnaire was developed by Erich et al. (1991). The questionnaire has 30 questions and is graded on a five-item Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree). Cronbach's alpha of the questionnaire was reported as 0.83. The reliability coefficient of the questionnaire in the present research was obtained using Cronbach's alpha coefficient. The coefficient was 0.81.

2- Compassion-Therapy Manual: Compassion-therapy sessions were held during 8 90-minute sessions for one month and two sessions per week at Center for Adolescent Intellectual Development, and the sessions were taught based on the compassion-therapy treatment protocol. The implementation method was conducted after determining the school and selecting the sample and making the necessary arrangements with the Center for Adolescent Intellectual Development to implement the intervention. First, 12 individuals were selected for the experiment and 12 ones were selected for the control, 10 people of which remained constant until the last session (2 participants from the experimental group were excluded due to the absence of more than two sessions in the post-test, and therefore, 2 people from the control group were excluded randomly). At the end of the intervention, both groups answered the questionnaires. The participants were assured that their information would remain completely confidential in order to comply with the ethical principles. On the other hand, the training for the control group was also implemented after the post-test. The members of the control group were selected from a school other than that of the participants of the experimental group in order to avoid interaction between the participants.

The intervention program adopted from Gilbert's self-compassion interventions (2021) was used for the teaching of compassion-therapy. These sessions were conducted in the form of 8 training sessions for 90 minutes during a month on a weekly basis (twice a week). A brief description of the sessions is given in Table 1. The content validity of the procedure for the current research was calculated by five faculties of Khomein and Arak Azad University using the Lavosheh method (CVR) and the coefficient was obtained to be 0.87. The Lavosheh coefficient was 1 for 1^st, 2^nd, 3^rd, 5^th, 7^th, and 8^th and it was 0.66 for the 4^th and 6^th sessions, and the total coefficient was 0.87.

Table 1. Compassion-therapy training sessions [16] and [17]

Homework	Practice	Content	Goal	Session
Noting the challenges that existed in life but were not mentioned in the questions	Providing a list of questions regarding the events that happened in life to identify challenges	Conducting the pre-test, familiarizing the group members with each other and the instructor, stating the rules and regulations of the group, explaining the variable, and preliminary introduction of compassion-based therapy.	Communication and brief introduction of compassion-based therapy	First
Reviewing and practicing the emotion regulation system and noting emotions in different situations	Getting to know compassionate people and a review of members' self-compassion	Explaining and describing compassion; applying compassion around problems and investigating any component of compassion in the members and identifying its characteristics	Recognition of the components of compassion-therapy	Second
Practicing empathy and self-compassion in the presence of three emotion regulation systems	Developing a compassionate mind, practical practice of empathy and sympathy	A review of the contents of the previous session, developing a sense of kindness and warmth towards oneself and training to understand that people feel that they should pursue the things with an empathic attitude. The formation and creation of more and more diverse feelings in relation to people's problems to increase care and to pay attention to their own health	Developing self-compassion in members by teaching empathy and compassion	Third
Stopping the voice of self-criticism and listening to the voice of encouragement and self-compassion	Socratic dialogue Question: What are the consequences of self-criticism or self-compassion?	Reviewing the contents of the previous session, teaching forgiveness, encouraging subjects to self-knowledge and to investigate their own personality, teaching and accepting mistakes and forgiving themselves for mistakes, identifying self-criticism and investigating reluctance to abandon it, and encouraging clients to consider compassion as an alternative of self-criticism	Self-knowledge and teaching clients to replace self-criticism with compassion.	Fourth
Focus on specific experiences. Paying attention to physical experiences, emotions, and thoughts	Mindfulness check Breathing mindfully two to five minutes a day	Reviewing the contents of the previous session, "creating a habit", paying attention to physical and emotional experiences, and thoughts. Paying attention to experiences as they are without judgment. Habit of implementation of mindfulness practice in life	Creating the ability and willingness to observe the body, feelings, and thoughts proficiently and usefully. Getting clients to pay attention that how much they feel to be threated, motivate or safe.	Fifth
Repetition and practice of visualization	Doing the practice of color of compassion, sound and visualization with a perspective of compassion	Reviewing the contents of the previous session, teaching responsibility-taking, which is the basic component of compassion-based therapy to create new and more efficient feelings and perspectives in oneself. Minimize self-evaluation thoughts using visualization technique to minimize the distractions caused by self-evaluation thoughts.	Teaching responsibility-taking, distress management, and creating a balance in emotions	Sixth
Writing a letter of compassion to herself	Practicing how to deal with the fear of compassion Practicing the self-compassion with mindfulness	Compassionate letter-writing, teaching self-compassion and acceptance of issues that a person has no role in creating them (metaphor of a paper person) and preparation for the group termination.	Working on threat-focused thoughts	Seventh
	Repetition and practice of empathy, compassion, and mindfulness	Reviewing and practicing the skills of the previous sessions, concluding the materials and trainings provided to help the participants to cope with different life situations and to perform the post-test.	Review, conclusion, practice, and repetition of skills.	Eighth

Hypothesis of this research: We hypothesize that training compassion-based therapy effectiveness on adolescent girls' suicidal thoughts.

Table 2. Descriptive findings of variables in the experimental and control groups

Experimental Group n= 10 Control group n= 10
Standard Deviation	Average	Standard Deviation	Mean	Variables	Step
6.46	95.80	4.94	96.30	Tendency to commit suicide	Pre-test
7.02	94.60	6.99	79.60	Tendency to commit suicide	Post-test

First, the assumptions of the one-way analysis of covariance test were investigated in order to investigate the hypotheses of the research. The results of the Shapiro-Wilk test indicated that the data distribution has the assumption of normality (experimental group: Z=84, DF=10, SIG=06, control group: Z=93, DF=10, SIG =46). The results of Levine's test for homogeneity of variance indicated that this assumption was also met (F=3.35, Df1=1, Df2=18, sig=084).

The results of Table 3 indicate that the F calculated to teach compassion-therapy has been influential on the suicidal thoughts of adolescent girls. The value of ETA coefficient indicates that education has explained 70% of the suicidal thoughts' variance. The value of statistical power indicates that if this research is conducted a hundred times, this result will be obtained every hundred times.

Table 3. Result of one-way analysis of covariance test

Statistical Power	ETA	Sig	F	Mean Squares	DF	Sum of Squares	Source
		0.03	11.71	360.96	1	360.96	Pre-Test
1	0.70	0.001	39.62	1221.05	1	1221.05	Group
				30.81	17	523.83	Error

The results of Table 4 indicate that there is a significant difference between the adjusted mean of the two groups. In other words, the mean experimental group in the post-test variable of suicidal thoughts was significantly lower than the control group.

Table 4. Result of Bonferroni test to compare the means

Sig

Standard Error

Mean Difference

Group

0.001

2.46

-15.67

Control

Test

The results of the findings indicate that the F calculated for compassion-therapy training has been influential on adolescent girls' suicidal thoughts, and this training has explained 70% of the variance of suicidal thoughts. In other words, the findings indicated that there is a significant difference between the adjusted averages of the two groups. The results of these findings are consistent with those of Nikbakht et al. (2023), Yang et al. (2022),Rahmani et al. (2022),Rashidi et al. (2022),Damavandian et al. (2022), Ahmadi et al. (2022), and Strandheim et al. (2014) [24]. Miri et al.'s studies (2022) showed that suicide attempts in students ranged from 6 to 8.3 percent and suicidal thoughts ranged from 2.8 to 7.49 percent. The most important suicide factors in this research were mental disorders, depression, loneliness, hopelessness, family factors, weak religious beliefs, stressor factors and low resilience [18]. In making an investigation into the effectiveness of compassion-based therapy on suicidal thoughts; the studies conducted by Nikbakht et al. (2023) indicated that the effect of compassion-therapy group on the post-test scores of ambivalence in emotional expression and impulsivity was significant at the level of 0.001 (19,20). Rahmani et al.'s studies (2022) indicated that mindfulness-based self-compassion treatment is influential in reducing intermediary affiliation and perception of being a burden, and the three-month follow-up also indicates the stability of therapeutic changes for intermediary affiliation and perception of being a burden (21,22). Compassion-therapy leads to resilience and avoids the emergence of temporary belongingness and perception of being a burden at the times of psychological distress by preventing the avoidance of painful emotions and thoughts caused by the disorder and development of the feeling of belonging to others and social connection. Prevents psychological distress. In explanation of the finding, it can be said that having self-compassion leads to forgiving one's failures and weaknesses and respecting oneself as a human being. In fact, self-compassion is a balanced cohesion between concern for self (self-concern) and concern for others, a state that researchers consider to be necessary for optimal psychological functioning. In fact, having self-compassion requires letting go of one's harmful behaviors and encouraging one to do things that are necessary for one's well-being. Now, if self-compassion is formed in a person, then compassion towards others will also be strengthened, and consequently, the person will experience more intimacy and empathy, and perceive a greater sense of competence that results from interacting with environment and using abilities. While students have a positive self-perception, especially in the field of social competence, sports competence, and self-esteem. All these factors cause the reduction of suicidal thoughts in adolescents. In another explanation, it can be said that people, who have high self-compassion, are more responsible for their problems and accept the events that happened more easily while being kind to themselves. Compassion-based therapy protects a person from negative states and thoughts by strengthening and creating compassion in a person through providing compassion techniques, identifying self-compassionate thoughts, as well as removing obstacles to compassion, and reduces the possibility of suicidal thoughts by strengthening and increasing positive emotional states. It is possible to enhance the adolescents' motivation by compassion-based therapy, and this itself leads to the acceptance of negative thoughts and their manipulation. Increased compassion can act as a buffer against the effects of negative events such as self-harm and suicide. People, who have high self-compassion, evaluate themselves less, are less strict on themselves and cope with problems and negative effects in life more easily (23).

In general, teaching compassion-based treatment skills to adolescents will make them kinder and compassionate towards past hardships, sufferings, and bitter experiences. Consequently, they will be kinder to themselves, blame and criticize themselves less, and reduce their negative thoughts, which in turn will cause the reduction or elimination of suicidal thoughts. From this research, it can be concluded that the self-compassion-based treatment is an effective strategy to help reduce the suicidal thoughts of adolescents due to its high efficiency, cheapness, and acceptance by adolescents. The code of ethics IR.IAU.NAJAFABAD.REC.1402.158 has been registered for the present research.

Ethic approval and consent to participate: We confirm that all methods were carried out in accordance with relevant guidelines and regulations.

We confirm that informed consent has been obtained from all participants in this research. Ethical approval for this study was obtained from the Azad University, Khomein of Iran Ethics committee (IR.IAU.NAJAFABAD.REC.1402.158).

Consent for publication: NOT APPLLICABLE.

Availability of data and materials: The data that support the findings of this study are available on request from the corresponding author, [initials]. The data are not publicly available due to [restrictions e.g. their containing information that could compromise the privacy of research participants].

Competing interests: This research has no competing interests.

Funding: The financial resources of this research were provided personally.

Author’s contributions:

Conceptualization has conducted by Hossein Davudi, Sogand Sobhani;

Methodology has conducted by Hossein Davudi, Maryam Ghasemi Motlagh;

Validation has conducted by Hossein davudi;

Formal analysis has conducted by Hossein Davudi, Sogand Sobhani Maryam Ghasemi Motlagh;

Investigation has conducted by Hossein Davudi, Maryam Ghasemi Motlagh, Sogand Sobhani;

Resources has conducted by Hossein Davudi, Maryam Ghasemi Motlagh;

Writing - Original Draft has conducted by Hossein Davudi, Maryam Ghasemi Motlagh , Sogand Sobhani;

All authors reviewed the manuscript.

Author’s information:

Hossein Davoudi ^{^[1]}Associate Professor, Counsel Department, Faculty of Humanities, Islamic Azad University, Khomein Branch, Khomein, Iran (corresponding author)

Email: [email protected]

ORCID: 0000-0002-4701-4958

Sogand Sobhani Master of Clinical Psychology, Faculty of Medical Sciences, Islamic Azad University, Arak, Iran

E-mail : [email protected]

ORCID: 0009-0005-9203-9803

Maryam Ghasemi Motlagh Department of Counseling, Faculty of Humanities, Khomein Branch, Islamic Azad

University, Khomein, Iran

Arak, Iran.

E-mail : [email protected]

ORCID: 0000-0009-4676-2782

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No competing interests reported.

Effectiveness of Compassion-Therapy Training on Suicidal Thoughts of Female Adolescents

Status:

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Abstract

Introduction

Methodology

Findings

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

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