Well this is interesting.  Here we are - Catero, my wife, and I - at the start of a five day workshop on "Mindful self-compassion" run by Chris Germer & Christine Brahler at Drangshlid, Eyjafjoll on the south coast of Iceland.  We flew into Reykjavik yesterday from Scotland, met up with a fellow course member who wanted to share transport, picked up our hire car and headed East on a two & a half hour or so's drive here.  Such a landscape ... bleak, beautiful ... in places a bit like driving across Rannoch Moor in Scotland.  And then arriving in time for supper.  Forty participants.  About twenty five are from Iceland and then there are about fifteen of us "foreigners".  And what a mix we foreigners are - from Estonia, Finland, Spain, Sweden, Germany, Canada and just three British.  The course is being run in English as Chris is from the States.  Sitting at the evening meal though, much of the conversation is in Icelandic.

Why am I here?  Well the evidence base for compassion-focused interventions in psychotherapy is gradually inching forward - see, for example, James Kirby's 2016 paper "Compassion interventions: The programmes, the evidence, and implications for research and practice" with its abstract reading "Purpose: Over the last 10–15 years, there has been a substantive increase in compassion-based interventions aiming to improve psychological functioning and well-being. Methods: This study provides an overview and synthesis of the currently available compassion-based interventions. What do these programmes look like, what are their aims, and what is the state of evidence underpinning each of them?  Results: This overview has found at least eight different compassion-based interventions (e.g., Compassion-Focused Therapy, Mindful Self-Compassion, Cultivating Compassion Training, Cognitively Based Compassion Training), with six having been evaluated in randomized controlled trials, and with a recent meta-analysis finding that compassion-based interventions produce moderate effect sizes for suffering and improved life satisfaction. Conclusions: Although further research is warranted, the current state of evidence highlights the potential benefits of compassion-based interventions on a range of outcomes that clinicians can use in clinical practice with clients. Practitioner points: * There are eight established compassion intervention programmes with six having RCT evidence. * The most evaluated intervention to date is compassion-focused therapy. * Further RCTs are needed in clinical populations for all compassion interventions. * Ten recommendations are provided to improve the evidence-base of compassion interventions."

I took my final medical exams in 1975, and had already been involved in psychological group training since 1972.  I guess I've been round the block a few times.  These waves of enthusiasm for particular subject areas & types of intervention wash up the psychotherapy beach pretty regularly.  Often there's a buzz of interest that feels more to do with fashion than hard evidence.  Early data is encouraging, sometimes ridiculously encouraging, and then ... if we're lucky ... the hard-nosed, high-quality research studies gradually help us understand what the new approach can offer and what it can't.  In many ways, compassion-based interventions are in this category.  In his systematic review, Kirby comments "Compassion is a growing area of interest within psychotherapy research (Gilbert, 2014; Kirby, Tellegen, & Steindl, 2016).  According to Google Scholar, in 2015 the term ‘compassion’ was referred to in a staggering 28,700 publications. Many researchers around the world are responsible for the rise of compassion as an area of scientific enquiry (Doty, 2015; Ekman, 2014; Germer, 2009; Gilbert & Choden, 2013; Keltner, Marsh, & Smith, 2010; Neff, 2003; Ricard, 2015; Singer & Bolz, 2013).  As a result, research is being conducted from the differing perspectives of evolutionary science, psychological science, and neuroscience, often in collaboration with spiritual teachers, to enhance our understanding of compassion and its associated impacts (Gilbert, 2014; Jazaieri et al., 2013)."  

But despite this flowering of interest, there are really very few good, relevant randomized controlled trials clarifying whether compassion-based interventions genuinely add to what we can already offer suffering clients in our work as psychotherapists.  Mindful Self-Compassion (MSC) training suffers considerably from this lack of firm underpinning.  There was an early research trial back in 2013 - "A pilot study and randomized controlled trial of the mindful self-compassion program" - which reported "OBJECTIVES: The aim of these two studies was to evaluate the effectiveness of the Mindful Self-Compassion (MSC) program, an 8-week workshop designed to train people to be more self-compassionate. METHODS: Study 1 was a pilot study that examined change scores in self-compassion, mindfulness, and various wellbeing outcomes among community adults (N = 21; mean [M] age = 51.26, 95% female). Study 2 was a randomized controlled trial that compared a treatment group (N = 25; M age = 51.21; 78% female) with a waitlist control group (N = 27; M age = 49.11; 82% female). RESULTS: Study 1 found significant pre/post gains in self-compassion, mindfulness, and various wellbeing outcomes. Study 2 found that compared with the control group, intervention participants reported significantly larger increases in self-compassion, mindfulness, and wellbeing. Gains were maintained at 6-month and 1-year follow-ups. CONCLUSIONS: The MSC program appears to be effective at enhancing self-compassion, mindfulness, and wellbeing."   This study, and numerous others, are freely downloadable from the excellent publications page on Kristin Neff's very helpful website.

So what are some of the key research questions in this area that I would like answers to?  Well, of course, are compassion-based interventions more effective than credible active control treatments?  As a sub-question to this first one, do compassion-based interventions differ in their outcomes from standard mindfulness-based trainings - and, if so, in what ways?  The recent paper "Phenomenological fingerprints of four meditations: differential state changes in affect, mind-wandering, meta-cognition, and interoception before and after daily practice across 9 months of training" throws some light on this.  And a third query is whether there are certain kinds of problem (for example, shame, depression, child abuse, eating disorder, etc) that particularly benefit from compassion-based approaches?  And it would be intriguing to see whether it matters with these kinds of interventions how much the training focus is on increasing self-compassion, and how much it's on increasing compassion for others - and whether some people benefit more from a higher ratio of one aspect and other people benefit more from another?

The much greater literature on mindfulness-based interventions suffers from some similar problems.  MacCoon & colleagues have contributed importantly to clarifying the situation with mindfulness.  They developed a credible active control intervention (involving exercise, diet & music) - see "The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR)" - and found "Participant-reported outcomes replicate previous improvements to well-being in MBSR, but indicate that MBSR is no more effective than a rigorous active control in improving these indices".   Subsequent excellent work by this research group has thrown doubt on the active mechanisms of mindfulness - "No sustained attention differences in a longitudinal randomized trial comparing mindfulness based stress reduction versus active control" - while also highlighting some possible intriguing specific benefits - "Reduced stress and inflammatory responsiveness in experienced meditators compared to a matched healthy control group". 

These kinds of doubts and research nudged me into developing a much broader-based training - "Life skills for stress, health & wellbeing" - which feels more solidly and broadly evidence-based.  But there are many good reasons for valuing compassion and, although I don't want to train as a Mindful Self-Compassion trainer, I do think there may be some interesting aspects of the next few days that will be useful both for me and for my work.  And what fun to come to Iceland and spend some days with dear Catero, my wife!