JMIR Publications

ABSTRACT

Background:

Up to a third of young people live with chronic physical conditions (e.g., diabetes, asthma, autoimmune disease), that frequently involve recurrent pain, fatigue, and daily functioning limitations, as well as stigma and isolation. These issues may be exacerbated as young people transition through adolescence and negotiate changing social roles, uncertainty about the future, and changes in care. Accordingly, young people with chronic illness are at high risk of psychological distress and report prevalence of mental illness more than double that of their physically healthy peers. Accessible, evidence-based interventions for young people with chronic illness are urgently needed to improve wellbeing, support adaptation and resilience, and enhance daily functioning. Self-compassion – an adaptive means of relating to oneself during times of difficulty – is a promising intervention target for this population.

Objective:

The objective of this study was to test the efficacy of a four-week, self-guided online self-compassion training for improving wellbeing among young Australians (16-25 years) living with a chronic medical condition. Primary outcomes were self-compassion, emotion regulation difficulties, and coping, while secondary outcomes were wellbeing, distress, and quality of life. We also sought to test whether change in primary outcomes mediated change in secondary outcomes, and to gather feedback about the strengths and limitations of the online program.

Methods:

We conducted a single-blind, parallel-groups, randomized controlled trial comparing online self-compassion training with waitlist control. Outcomes were assessed at four (T1) and twelve weeks (T2) post-baseline. A mixed methods approach was used to evaluate program feedback.

Results:

151 (Mage= 21.15 years; 87.4% female) young people were randomized to the intervention (n = 76) and control (n = 75) groups. Loss-to-follow-up was 47.4%, and of those who provided post-test data, only 42.5% of young people in the experimental group completed 100% of the online program. The main reported barrier to completion was a lack of time. As anticipated, treatment effects were observed for self-compassion (small effect), wellbeing (medium effect) and distress (small-medium effect) at post-test and maintained at follow-up. Contrary to our hypotheses, no intervention effects were observed for emotion regulation difficulties or maladaptive coping. Improvements in adaptive coping were observed at post-test but not maintained at follow-up. Self-compassion, but not emotion regulation difficulties or coping, mediated improvements in wellbeing.

Conclusions:

This study demonstrates that minimal-contact online self-compassion training can confer benefits for self-compassion, wellbeing and distress among young people with chronic conditions, although program engagement and retention is suboptimal. Future work should focus on refining program content, engagement, and delivery to optimise engagement and treatment outcomes for the target group. Clinical Trial: ACTRN12619000572167; UTN U1111-1231-4502