Physiological Response to Self-compassion Versus Relaxation in a Clinical Population
Phase: NA
Conditions: Depression, Anxiety Disorders
Sponsor: University of Los Andes, Columbia

Project Title:  Exploration of responses to compassion in a clinical population 
 
NCT number: TBC 
 
Date: 20th March 2018 
 
 
 

Project executive summary  
This project focuses on exploring responses to compasionate imagery, a technique from  
Compassion Focused Therapy (CFT; Gilbert, 2014). Evidence has documented that CFT 
decreases depression, shame, self-criticism and increases self-esteem (Kirby, 2016).  
Compassion-focused imagery (CFI) is a key technique in CFT, which involves visualizing 
compassion towards others, or imagining people, places or objects directing compassion 
towards oneself. Single trials of CFI have shown a reduction of negative affect and 
physiological changes associated with the attenuation of threat-focused behaviors (e.g. 
Rockliff et al., 2008). Regular CFI practice has increased self-compassion and reduced 
negative affect in both clinical and non-clinical populations (Gilbert & Irons, 2004; 
McEwan & Gilbert, 2016).  Unfortunately, CFI can create threat-focused responses in some 
individuals. However, these findings have been based on tasks involving receiving 
compassion from others.  
The present study therefore aimed to explore participants’ responses to imagery exercises 
involving self-compassion, in comparison to a relaxation task (to control for certain task 
demands but without the compassion element), and a control task ( reading a magazine).  
GENERAL OBJECTIVE 
 
To explore responses to self-compassionate imagery in comparison to relaxation and a 
control task, in a clinical population. 
SPECIFIC OBJECTIVES 
1. How do clinical participants initially respond to self-compassionate imagery in 
an initial trial, compared to relaxation and a control task? (using self-report and 
HRV measures) 
2. Do any threat responses reduce following repeated trials of self-compassionate 
imagery?  
METHODS  

Participants and process of recruitment:  
We plan to recruit a sample of 25 participants for this study, based upon other studies of 
compassionate imagery with similar designs (Rockliff et al., 2008; Duarte et al., 2015). 
Inclusion criteria are:  
1.Clinical level of anxiety or depression (defined for this study ≥ 8 on the OASIS or 
ODSIS) 
2. High self-criticism (we selected a cut-off of 0.5 standard deviations above the mean in 
self-inadequacy or self-hatred on the FSCRS). Based upon a validation in Colombia of 
the FSCRS by Naismith, Duran Ferro, Ingram, & Jiménez Leal (Submitted), this 
represents ≥ 24 in self-inadequacy or ≥ 8 in self-hatred.  
 
These criteria were selected because these interventions are designed to help a clinical 
population presenting with high self-criticism. Offering this to a non-clinical population 
(i) reduces the likelihood of observing significant changes, and (ii) will not allow us to 
help those who present with higher needs.  
 
Nonetheless, those who complete the initial screening and do not meet inclusion criteria 
will be invited to a group session to learn compassion techniques. They will also receive 
compassion materials via email at the end of the study.  
 
For recruitment, posters will be hung inside the campus of the University of the Andes. 
The same information will be published in university social media pages.  
 
Design: 
Participants will be randomized to complete 3 or 4 trials (see details below) using a 2:1 
ratio, using a randomization sequence drawn up prior to the study start. This will allow us 
to explore in a small subgroup whether a fourth trial impacts results. We are also running a 
related study, which will explore the effects of psychotherapy that will be offered following 
these 3-4 trials, and we anticipate that a fourth trial will increase probability of dropout from 
the second study, therefore we will not assign all participants to do the fourth trial. 
Measures: 
See Appendix 2 for copies of the questionnaires that we intend to use that are not validated. 
1. Demographics 
2. Self-report form – Physiological variation  
3. Overall Depression Severity and Impairment Scale (ODSIS)  
4. Overall Anxiety Severity and Impairment Scale (OASIS) 
5. Forms of Self-Criticism/Attacking and Self-Reassuring Scale (FSCRS) 
6. Positive and negative affect generated 

7. Heart Rate Variability (HRV). Heart rate variability (HRV) is a physiological 
measure that allows us to quantify small changes in anxiety moment by moment, 
that a questionnaire cannot quantify. In this study it will allow us to measure 
whether participants respond to compassion with a threat-based response or a 
relaxed response (we expect that after 3-4 trials, all participants will respond with 
relaxation or a neutral response, but we predict that at the start, some will respond 
with threat-based responses).  
 
We will use the BioPac system to collect HRV data. Electrodes will be placed using the 
Lund guidance which is considered the most stable, least invasive, and with high 
diagnostic accuracy. Using the program Acqknowledge, we will analyse beats per minute 
(BPM) and ratios of sympathetic and parasympathic activity. Specifically, we will use the 
Root Mean Square of the Successive Differences (RMSSD) of RR intervals (Task Force 
of the European Society of Cardiology and the North American Society of Pacing and 
Electrophysiology, 1996). RMSSD was selected because there is no agreed clinically-
significant change value for anlysing HF HRV data (see Data analysis section). 
 
Procedure 
Participants will complete an initial screening questionnaire online including: an informed 
consent (see Appendix 1), demographics questions, ODSIS, OASIS and FSCRS. Eligible 
participants will be invited to attend in-person sessions. In each session, HRV will be 
measured by a research assistant whilst the participant engages in three 4-minute tasks in 
the following order:  
• Control task:  participants will read a magazine with neutral content for 4 minutes 
• Relaxation imagery (see appendix 3): participants will complete a relaxation 
exercise of beach or forest imagery for 4 minutes. 
• Compassion-focused imagery: participants will complete a compassion-focused 
imagery for 4 minutes (see appendix 3). 
 
Data analysis  
Paired t-tests will be run (i) to estimate differences in HRV during the self-compassion 
imagery, relaxation imagery and the control task, (ii) to examine changes in self-reported 
positive and negative affect from pre-CFI to post-CFI, (iii) to explore whether changes in 
positive and negative affect during CFI are greater or smaller from Trial 1 to Trial 3. 
To complement group-level analyses, we will use reliable and clinically-significant change 
analyses. We will firstly report how many participants show a reliable change (Jacobson 
& Truax, 1991) in positive or negative affect following CFI.  
We will also calculate how many individuals show a clinically-significant HRV response 
(≥ 5ms change in RMSSD within one individual between two different tasks).  
Finally, we will report the number of positive and negative clinically-significant responses 
for both relaxation and compassion in each trial,  in order to (i) compare effects of 
compassion versus relaxation at trial 1, and (ii) explore whether repeated trials improved 
response to each task.  

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