Articles Section

Journal of Evidence-Based Psychotherapies,
Vol. 24, No. 2, September 2024, 69-104.

10.24193/jebp.2024.2.12

THE EFFECTIVENESS OF COMPASSIONATE MIND
TRAINING (CMT) FOR UNDERGRADUATE STUDENTS
Tünde Póka1* and Andrea Barta2
Evidence-Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai
University; Department of Applied Psychology, Babeș-Bolyai University Cluj-Napoca,
Romania. ORCID ID https://orcid.org/0000-0003-1919-2375; e-mail: tunde.poka@ubbcluj.ro2
Evidence-Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai
University; Department of Applied Psychology, Babeș-Bolyai University Cluj-Napoca,
Romania. ORCID ID https://orcid.org/0000-0001-8754-6097; e-mail: andrea.barta@ubbcluj.ro
1

Abstract
The study aimed to investigate the feasibility and effectiveness of face-toface, group-based Compassionate Mind Training (CMT) for undergraduate
students.
Following a 12-week CMT intervention, a cohort of undergraduate students
in the CMT group (n = 45) and their counterparts in the passive control group(n = 21) were asked to fill out assessments before, during, immediately after,
and three months following the completion of the intervention. These
measures encompassed a range of factors, including self-compassion,negative affect, various forms of positive affect, depression, anxiety, stress,
life satisfaction, and dysfunctional attitudes.
Compared with the control group, participants belonging to the CMT group
showed significant increases in self-compassion and self-warmth, along withdecreases in negative affect, self-coldness, dysfunctional attitudes,
depression, and stress. However, mediation analyses, when applied withinlongitudinal models, did not establish the significance of self-compassion,
self-coldness, or self-warmth as mediators in the context of the CMT's
impact on negative affect and soothing positive affect.
The results support the effectiveness of a 12-week, group-based, face-to-face
CMT for undergraduate students. Yet, they also cast doubt on selfcompassion as the primary mechanism driving these changes, given theabsence of supporting longitudinal evidence.
Keywords: self-compassion, intervention, students, CMT, affect.

concerning this article should be addressed to Tünde Póka, Babeș-Bolyai
University, Faculty of Psychology and Educational Sciences, Department of Applied Psychology,
No. 128 December 21, 1989 Boulevard, 400603, Cluj-Napoca, Romania.
E-mail: tunde.poka@ubbcluj.ror* Correspondence

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Undergraduate students report reduced well-being and increased
psychological distress compared to the general community (Bore et al., 2016;
Larcombe et al., 2016; Regehr et al., 2013), therefore it is essential to design effective
interventions in order to reduce their distress and improve their well-being. Several
factors can constitute sources of distress: academic performance, pressure to
succeed, post-graduation plans, financial worries, quality of sleep, relationship withfriends, relationship with family, general health issues, body image, and self- esteem(Beiter et al., 2015). Given that they are particularly vulnerable to perfectionismrelated distress (Arpin-Cribbie et al., 2012) and self-criticism is a transdiagnostic
factor in psychopathology (McIntyre et al., 2018), it is also crucial to developinterventions that can effectively manage their self-criticism. One promising way toreach these goals is through the cultivation of self-compassion (Dundas et al., 2017;
Mantelou & Karakasidou, 2017). Self- compassion can be described as a healthy
attitude towards one's pain and suffering, which is an integral part of human life. It
implies a gentle, understanding, and supportive approach towards oneself, instead of
employing harsh self-criticism (Germer, 2009; Neff, 2003a). Furthermore, selfcompassion is a provably acquirable skill with numerous advantages (Ferrari et al.,2019, Póka et al., 2023).
In addition to longer and more complex self-compassion programs, such as
the Mindful-Self Compassion (MSC) program (Neff & Germer, 2012) andCompassionate Mind Training (CMT; Irons & Heriot-Maitland, 2021), researchers
are also investigating the effectiveness of simpler, shorter interventions for
improving distress and well-being levels. For example, writing self-compassionate
letters (an exercise most commonly used in studies to elicit and increase selfcompassion) can reduce negative emotional states (Leary et al., 2007) anddepression, as well as increase happiness levels in the general population (Shapira &Mongrain, 2010).
Promising results emerge from meta-analyses investigating interventions
aimed at enhancing self-compassion (Ferrari et al., 2019) and general well-being(Zessin et al., 2015). They also demonstrate effectiveness in fostering positive affect,
mindfulness, life satisfaction, eating behaviors, and body image; furthermore, theseinterventions show efficacy in mitigating negative affect, eating pathology,
depression, stress, anxiety, self-criticism, and rumination (Ferrari et al., 2019; Póka
et al., 2023; Turk & Waller, 2020; Wakelin et al., 2022). Notably, the acquisition ofself-compassion is particularly attainable within group settings and through inperson intervention methods (Ferrari et al., 2019; Póka et al., 2023). However, itappears that self-compassion interventions commonly utilized among college
students, such as self- compassion writing exercises, exhibit reduced benefits
compared to their general effectiveness (Ferrari et al., 2019; Póka et al., 2023). It istherefore important to develop and adapt interventions tailored towards them,potentially yielding greater success in fostering self- compassion, enhancing wellbeing, and alleviating distress. A promising avenue in this pursuit is Compassionate
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Mind Training (CMT; Irons & Heriot-Maitland, 2021), a group intervention
conducted in person and rooted in the principles and application of CompassionFocused Therapy (Gilbert 2009a, 2009b, 2014), which appears to hold considerable
promise for achieving these objectives.
The Compassionate Mind Training
The Compassionate Mind Training (CMT; Irons & Heriot-Maitland, 2021)
is a group- based, 8-session program, split into 2.5-hour sessions every week. The
program integrates a solid theoretical foundation encompassing written, imaginative,
meditative, and body based exercises (Gilbert 2009a, 2009b, 2014). Throughout thetraining, participants acquire knowledge about the development and operation of themind, what functions it serves, and what factors influence it. This accumulation of
insights contributes to a reduction in feelings of shame and blame. Participantsrealize that we all have a brain, a mind, that although it has many benefits, it is also
likely to create problems for us, but it wasn't our choice to be built that way.
Furthermore, we did not choose the context in which we were born, although these
aspects have a huge influence on how we function today. The key message conveyed
through this methodology emphasizes that one is not at fault, but at the same time,
one bears a sense of responsibility. Participants are introduced to the definition ofcompassion as a motive (compassion being defined as the sensitivity to suffering, as
well as the attempt and commitment to alleviate or prevent it), the three flows ofcompassion (self-compassion, compassion for others, and compassion from others),
the two psychologies of compassion (engagement and action), the competencies
required for compassion, the three main qualities of compassion (strength, wisdom,
engagement), the three basic emotion regulation systems (threat, drive, and soothing
system), and the function of compassion in regulating these systems (Gilbert, 2009a,
2009b, 2014). Through the program, participants engage in a range of activities
aimed at cultivating a compassionate mindset. These activities include imaginative
exercises like the compassionate place and compassionate image, body-centeredexercises like compassionate breathing and compassionate touch, and written
exercises such as composing compassionate letters and exploring the concept of“multiple selves,” among others. Moreover, participants can openly discuss theirexperiences within small group settings, as well as with the larger group as a whole.
The results of the preliminary investigations show that CMT is a feasible
and effective intervention for the general population. It has the potential to improve
all three flows of compassion while nurturing positive emotions and a sense of wellbeing (including physiological well-being measured by heart rate variability) (Irons& Heriot-Maitland, 2021; Matos et al., 2017). Furthermore, it has been shown to
reduce self-criticism, shame, fears of compassion, and distress (Irons & HeriotMaitland, 2021; Matos et al., 2017). Findings have highlighted the importance ofimproving one’s self-compassion for overall increases in well- being and decreases
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71Articles Sectionin psychological distress (Irons & Heriot-Maitland, 2021). The results of Matos andcolleagues’ (2022) study further confirmed that self-compassion was the main
mechanism of change in a two-week CMT intervention. Self-compassion acted as amediator for the intervention's impact on various factors, including self-criticism,
depression, stress, and shame, as well as positive emotional states like safe andrelaxed feelings. These interventions are particularly recommended for individuals
grappling with elevated levels of shame and self- criticism, who find it challenging
to engage in self-soothing and self-acceptance (Gilbert, 2009a, 2009b, 2014; Gilbert& Procter, 2006). Given that college students are exceptionally vulnerable toperfectionism-related distress (Arpin-Cribbie et al., 2012), and self-criticism is atransdiagnostic factor that can predict symptoms of psychopathology among them(especially depression) (McIntyre et al., 2018), this group-based intervention may be
optimal for this population in reducing their distress levels.
Beaumont and Martin (2016) emphasized the importance of developing selfcompassion and compassion for others in therapy students using Compassionate
Mind Training. Given the high rates of burnout and high levels of psychologicaldistress experienced by psychological therapists (especially younger and newer
therapists), self-compassion can be an important personal resource for them,increasing their well-being and reducing distress (Boellinghaus et al., 2013; Finlay,Jones et al., 2017; Yela et al., 2020), as well as the levels of burnout among them
(Eriksson et al., 2018; Gerber & Anaki, 2021). Beaumont et al. (2021) adopted amixed-methods approach, employing both qualitative and quantitative techniques toinvestigate the effectiveness of a 12-week CMT intervention for students pursuing
careers in helping professions. Their findings also demonstrated promising outcomes
regarding the viability and effectiveness of the intervention within an academic
setting. However, it's worth noting that this study primarily focused on selfcompassion and self-criticism and did not encompass clinical outcomes (such as
negative affect, depression, anxiety, stress, etc.) or markers of well-being (likepositive affect, life satisfaction, etc.). The results of the qualitative data suggested
that personal practice and self-reflection are important aspects of cultivating acompassionate mindset and increasing levels of self-compassion (Beaumont et al.,2021).
Objectives
The main objective of the current study was to investigate the effectivenessof Compassion Mind Training for improving undergraduate students’ well-being andreducing their distress. The primary outcomes examined encompass the influence on
negative affect and soothing positive affect. Secondary outcomes include several
other distress indicators (i.e., depression, anxiety, and stress), as well as indicatorsof well-being (i.e., activating positive affect and life satisfaction). We also aimed to
explore the pathways leading to the impact of the intervention using mediation
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analyses. Given that cross-sectional analyses may indicate the existence of asignificant indirect effect, even if the true longitudinal indirect effect is shown to be
zero (Goldsmith et al., 2018; Maxwell et al., 2011), the present study sought toexplore the longitudinal mediation roles of self-compassion and dysfunctional
attitudes concerning the clinical benefits resulting from the intervention, particularly
focusing on the primary outcomes: the aforementioned negative and soothing
positive affect, respectively.
Based on the importance of distinguishing between self-warmth (positive
dimensions of self-compassion, compassionate behaviors) and self-coldness(negative dimensions of self- compassion, uncompassionate behaviors) (Chio et al.,2021; Muris and Petrocchi, 2016), we also aim to investigate the individual
longitudinal mediation roles of self-warmth and self- coldness.
Hypotheses
Based on the literature, it was expected that the implementation ofCompassionate Mind Training would effectively reduce students’ negative affectand improve their soothing positive affect. Following the intervention, it was
anticipated that students belonging to the intervention group would report lower
levels of negative affect and higher levels of soothing positive affect compared tothose in the control group. Additionally, our hypotheses proposed that this training
regimen would lead to enhancements in self-compassion, self-warmth, and otherindicators of well-being, such as activated positive affect and life satisfaction.
Concurrently, we hypothesized that it would also result in a reduction in selfcoldness, dysfunctional attitudes, and other signs of distress, including depression,anxiety, and stress.
Finally, we predicted that the effects of the intervention on negative affectand soothing positive affect would be mediated by self-compassion. This implies
that participation in Compassionate Mind Training would lead to the observed
reduction in negative affect and an increase in soothing positive affect through thegrowth of self-compassion, particularly by addressing self-coldness.

MethodParticipants
We conducted an a priori power analysis using G*Power 3 (Faul et al., 2007)
to determine the required sample size. For a mixed ANOVA involving two groups
and four measurements, with a significance level of 0.05 and a desired statisticalpower of 0.80, the analysis indicated that a sample size of n = 24 would be needed
to detect a medium effect size (f = 0.25). In the case of an independent t-test, also
Compassionate Mind Training for Students73Articles Section

with a significance level of 0.05 and a desired statistical power of 0.80, the analysis
showed that a sample size of n = 128 would be required to detect a medium effectsize (d = 0.5). The intervention group consisted of second- year undergraduate
students majoring in Psychology, while the control group comprised second-year
undergraduate students from other majors. The allocation was non-random (i.e., thePsychology students sought students to be part of the control group, matched in termsof age and declared gender). The participant recruitment and flow are depicted in
Figure 1.

Figure 1. Participants’ Flow

Initial measurements were carried out by 124 students, with 67 being fromthe CMT group and majoring in psychology, while 57 belonged to the control groupand pursued other majors. A substantial proportion of the participants were identified
as female, accounting for more than 80% of the total. Notably, the overall dropout
rate was 46.77%, with a comparatively lower dropout rate observed in the CMT
group at 32.83%, as opposed to the control group's rate of 63.15%.

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Instruments
Self-Compassion, Self-Warmth, and Self-Coldness
Self-compassion, self-warmth, and self-coldness were assessed using the SelfCompassion Scale – Short Form (SCS-SF; Raes et al., 2011), a 12-item version of
the original Self-Compassion Scale (SCS; Neff, 2003b). The SCS-SF appraises eachfacet of self- compassion (i.e., self-kindness, self-judgment, common humanity,
isolation, mindfulness, over-identification) through two items for each component(e.g., “I try to see my failings as part of the human condition”). Participants
responded on a five-point Likert scale. To calculate self-compassion results, theaverage of the six items measuring self-compassionate behaviors (self-kindness,
common humanity, mindfulness) was computed, while scores for uncompassionate
behaviors towards oneself (self-judgment, isolation, over-identification) werereverse-coded and averaged. Similarly, self-warmth (self-compassionate behaviors)and self-coldness (uncompassionate behaviors) scores were determined by averaging
the respective subscale items (items measuring uncompassionate behaviors were notreverse-coded to calculate self-coldness). Elevated scores on self-compassion, selfwarmth, and self-coldness indicated higher levels of those qualities. The scale
exhibited acceptable internal consistency for the global self-compassion indicator(α = .76) and self-coldness (α = .75, while the internal consistency of the selfwarmth subscale was considered questionable (α = .64).
Depression, Anxiety, and Stress
Levels of depression, anxiety, and stress were assessed using the 21-item
version of the Depression Anxiety Stress Scale (DASS-21; Lovibond & Lovibond,1995). Participants provided ratings on a scale ranging from 0 (does not apply to me
at all) to 3 (applies to me very much, or most of the time) to indicate the frequencyof their typical experience of each symptom. Subsequently, scores for the variables
were obtained by summing up the seven items pertaining to stress, depression, andanxiety, respectively. The total score for each subscale was then doubled. Higherscores indicate higher levels of depression, anxiety, and stress. In the current study,
the DASS-21 demonstrated good internal consistency for depression (α = .87), alongwith acceptable consistency for both anxiety (α = .77) and stress (α = .77).
Negative AffectTo measure the subjective dimension of distress (i.e., negative affect), we
used the abbreviated Hungarian version of the Emotional Distress Profile (Profilul
Distresului Emoțional - PDE; Opriş & Macavei, 2005). The scale was originallydeveloped and validated in Romania and presents good psychometric properties andexcellent internal consistency (α = 0.94) as a complex indicator of emotional
distress.
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The original scale consists of 26 adjectives describing negative affect, suchas “sad” and “depressed”. The present study utilises 12 items that had adequate facevalidity according to the translation. Participants were asked to rate on a five-point
Likert scale the extent to which the given affective items were typical of theirexperiences in the past two weeks. The scale exhibited very good internalconsistency (α = 0.89) in measuring negative affect in the present sample.
Soothing and Activating Positive Affect
The various types of positive affect (i.e., soothing and activating positive
affect) were assessed using the Types of Positive Affect Scale (Gilbert et al., 2008),
which consists of 18 items appraising three distinct types of positive affect (soothing,relaxing, and activating positive affect). Participants rated their alignment with eachstatement on a scale ranging from 1 (Not characteristic of me) to 5 (Verycharacteristic of me). The scale measures the extent to which participants experience
these feelings frequently. The variable scores were calculated by summing thededicated items. In this study, the focus was on measuring soothing and activating
positive affect. The subscale assessing soothing positive affect exhibitedquestionable internal consistency (α = .60), while the subscale evaluating activating
positive affect demonstrated acceptable internal consistency (α = .75). The results
mirror those of the original English instrument, where the activating positive affectsubscale displayed higher internal consistency (α = 0.83) compared to the subscalemeasuring feelings of safeness/contentment positive affect (α = 0.73).
Dysfunctional Attitudes
The Dysfunctional Attitude Scale (DAS; Weissman & Beck, 1978) is a selfreport instrument designed to measure the presence and intensity of dysfunctional
attitudes. The Hungarian version of the DAS (Kopp, 1985) is composed of 35 items,with each of the seven categories of dysfunctional attitudes (need for approval, needfor love, need for achievement, perfectionism, entitlement, omnipotence, andautonomy) encompassing five items. These are rated on a 5-point Likert scaleranging from -2 (strongly disagree) to 2 (strongly agree). As an illustration, an item
assessing the need for approval is: “I need other people’s approval in order to be
happy”. For the purposes of this study, an aggregate measure of dysfunctional
attitudes was computed by summing the individual item scores. The scale exhibited
good internal consistency in capturing dysfunctional attitudes (α = .83).
Life Satisfaction
The five-item Hungarian version of the Satisfaction with Life Scale (SWLS;
Diener et al., 1985; Martos et al., 2014) was chosen as the tool to gauge participants’alignment with statements concerning their overall perceived well-being. Thesestatements include phrases such as “In most ways, my life is close to ideal”, andparticipants rate their agreement on a scale from 1 (strongly disagree) to 7 (strongly
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agree). The variable scores were derived by summing the item ratings. The SWLS
has shown high internal consistency, test-retest reliability, and validity (Diener et al.,1985). Additionally, good internal consistency was also confirmed in the current
study (α = .80).
Procedure and Design
The study was undertaken following the Code of Ethics of the American
Psychological Association and was approved by the local Ethics Committee.
Employing an interventional design, this study followed a parallel non-randomized
allocation involving multiple assessments, specifically a 2 (group: intervention,
passive control) by 4 (time: T1: baseline, T2: mid-test, T3: post-test, T4: 3-monthfollow-up) matrix. The data collection process was conducted online using Google
Forms at each of the four time points (T1: early October 2022, T2: mid-November
2022, T3: mid-January 2023, and T4: mid-April 2023).
The primary focus of measurement encompassed negative affect andsoothing positive affect. However, additional factors were also assessed, including
various indicators of distress (such as depression, anxiety, and stress) and well-being(such as activating positive affect and life satisfaction). Furthermore, the study also
evaluated potential underlying mechanisms, including self-compassion, selfcoldness, self-warmth, and dysfunctional attitudes.
The intervention group consisted of second-grade undergraduate students
majoring in Psychology, while the control group comprised second-grade
undergraduate students from other majors matched in terms of age and declared
gender. No group intervention was administered to the control group throughout the
study period. This pragmatic trial was conducted to assess the feasibility andeffectiveness of Compassionate Mind Training within an academic setting, reflecting
real-world circumstances.
The Compassionate Mind Training (CMT) for students embodies a 12session group program, each lasting about 2 hours, including a ten minutes break
mid-session. This intervention was developed by drawing upon existing protocols
and manuals for cultivating a compassionate mindset (Beaumont & Martin, 2016;
Gilbert, 2009b; Irons & Beaumont, 2017; Irons & Heriot-Maitland, 2021). The
training was delivered weekly in a face-to-face format in an academic context by anaccredited CBT and CFT psychotherapist (the first author). A two- week break wasincorporated during holidays, during which participants were encouraged to continue
practicing. The sessions had the following structure: 1) Beginning (grounding
exercise, reviewing the weekly practice); 2) Exploration of the designated session
theme (psychoeducation, experiential activities, writing tasks, reflections in smalland large group settings); 3) Ending (session summary and reflections, outlining
practices for the following week).
Participants exclusively shared personal information and experiences that
related to the model, and only engaged in exercises they felt comfortable with.
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During exercises, participants were guided to focus on mild to moderate concerns,
avoiding overwhelming issues. A short outline of each session is provided in Table
1. Supplementary materials were available to aid weekly practices, including audio
files, written handouts encompassing ideas discussed in each session, andworksheets to facilitate independent practice during the week. Encouragement was
extended for daily practice, and at the start of each session, discussions centered onhome practice, encountered challenges, and strategies for managing them.
Data Analysis
Preliminary analyses and evaluations of the intervention's impact on primary
outcomes, secondary outcomes, and potential mechanisms were conducted using
SPSS 20 software. A series of Mixed-Model ANOVA and Mixed-Model ANCOVA
analyses were performed, followed by Sidak post-hoc tests. Effect sizes were
quantified using partial eta squared (ηp2) and Cohen’s d, wherein values of ηp2 = .14
and d = .8 corresponded to a large effect size, ηp2 = .06 and d = .5 denoted a medium
effect size, and ηp2 = .01 and d = .2 indicated a small effect size (Cohen, 2013;
Tabachnick & Fidell, 2013).
To examine mediation effects, Structural Equation Modeling (SEM) was
employed within the SPSS AMOS 20 software, utilizing Maximum Likelihood (ML)estimation. The bootstrap method was applied to assess longitudinal indirect effects,
generating 5000 samples to establish a 95% confidence interval. The significance ofeffects was determined based on whether the confidence intervals derived from thebootstrap analysis excluded zero (Hayes, 2018; Preacher & Hayes, 2004).
We also used the PRECIS – 2 (Loudon et al., 2015) toolkit to assess how
this intervention works in a real-world setting, and therefore to evaluate theapplicability of the results. The following nine domains were rated on a five-point
scale, ranging from 1 – very explanatory to 5 – very pragmatic: Eligibility Criteria(5), Recruitment Path (5), Setting (3), Organisation intervention (4), Delivery (5),Adherence (4), Follow up (5), Outcome (5), and Analysis (3). Values in parentheses
represent the scores assigned to each domain. Participants in the study were similar
to those who would benefit from this intervention (we had no exclusion criteria).
Recruitment of participants from the intervention group also did not demand extra
effort. Although the intervention setting was similar to the usual care setting(academic setting), we did not include more academic settings in this research. We
gave a score of 4 for Organisation, based on the resources and provider expertise
required to deliver the CMT intervention. We also gave a score of 5 for flexibility of
implementation (for example, there was a 2-week break during the holiday period).
Our evaluation also showed a high degree of flexibility in terms of adherence (similar
to the flexibility of usual care). In terms of the Follow- up and Primary outcome, we
also rated this study as pragmatic rather than explanatory, but we scored pragmatism
lower based on the primary analyses.
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Table 1. Outline of the 12-week CMT group for students (CMT)
SessionContent

Practices1

Exploration of the model,
defining compassion Reality
checks concerning suffering
Understanding the concept ofthe „tricky brain” Building
capacities for compassion
Exploration of the threeemotion regulation systems(i.e., threat, drive, andsoothing), and the importanceof balance between themCompassionate Landing
Mindfulness of breath
Mindfulness of bodysensations Mindfulness ofthoughts

Compassionate Landing
Reflections

Compassionate Landing
Three Emotional System
Visualisation
The Exploration of theThree Emotion Systems in
Personal Life (Global)
Compassionate Landing
Conceptualization of own
situation Public Speech
Visualisation Soothing
Rhythm BreathingCalming Smile, Touch, andInternal Voice
Compassionate Landing
Contemplating the realities
of life Compassionate Place
Compassionate Color

Compassionate Landing
The Exploration of theThree Emotion System in
Personal Life (Day by Day)
Reflections

2

3

4

5

6

7

Conceptualization of one’s
own situation and reflection
Identifying primary fears,
coping strategies, andunexpected outcomes
Building compassionate
motivation
Building compassionate
motivation
Exploring the concept ofcompassion and its attributes
Delving into the dual
psychologies underlying
compassion
Unraveling the notion ofmultiple selves Compassion
as Flow – directing
compassion to others
Addressing fears, blocks, andresistanceCompassion as Flow –embracing compassion fromothersAddressing fears, blocks, andresistanceCompassion as Flow –focusing on self-compassion
Discussing fears, blocks, andresistanceHome Practices

Soothing Rhythm Breathing
Conceptualization of own
situation Reflections

Soothing Rhythm Breathing
Compassionate Place
Reflections

Compassionate Landing
Compassionate Self –Compassionate Memory –Acting and Embodiment
Feeling Compassion for
Displaying compassion in
Otherseveryday life Reflections
Compassionate Self –Acting and Embodiment„He/ She is just like me”
Compassionate Landing
Observing and describing
Memories of Compassionate the compassionate attitudes
Others Compassionateof others
Creature
Reflections
Role Play
Compassionate Landing
Compassionate Self –The Compassionate Self
Acting and Embodiment
helps the other Self who is
Self-Compassion Journal
suffering
Reflections
Mirror practice
Writing a compassionate
letter to the Self

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SessionContent

PracticesHome Practices

8

Recapitulating the threeemotional regulation systems(i.e., threat-, drive- andsoothing systems) Learning
about the three directions ofcompassion

Compassionate Self –Acting and Embodiment
Displaying Compassion in
Everyday Life
Observing and Describing
the Compassionate Attitudesof Others
Reflections

9

Discussing the concept ofmultiple selves
Exploring different emotional
reactions, and directing
compassion towards them
Exploring the functions ofself-criticism and shame, anddirecting compassion towards
itCompassionate Landing
The Exploration of theThree Emotion System inthe Last Week
The Compassionate Self
helps the other Self who issuffering„He/ She is just like me”
Role Play
Compassionate Landing„Multiple Selves” exercise

10

11

12

80

Compassionate Self –Acting and EmbodimentSelf-Compassion Journal
Reflections

Compassionate Landing
Compassionate Self –Directing Compassion
Acting and Embodiment
Towards Shame Awareness Self-Compassion Journalof the Inner Critic
Reflections
Two Teachers
The Compassionate Self
helps the Inner Critic
Multiple Self Exercise
Using the compassionate
Compassionate Landing
Compassionate Self –mind in the context of work
Compassion Towards
Acting and Embodimentand study
Shame Compassionate
Self-Compassion Journal
Letter Awareness of theReflections
Inner Critic
Replacing shame-based selfcriticism withcompassionate selfcorrection
The ideal teacher/boss„Multiple Selves” exercise
Sustaining the compassionate Compassionate Landing
mind and reviewing theContemplating the realities
model
of life
The Exploration of theThree Emotion Systems in
Personal Life (Global)
The Future Compassionate
Self My new compassionate
story

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Results
Preliminary analyses
Based on skewness and kurtosis, all investigated variables exhibited anormal distribution across every time point. The descriptive statistics for both groups
during each time point are presented in Table 2.
Table 2. Descriptive Statistics

Negative AffectDepression
Anxiety
StressSoothing Positive
AffectActivating Positive
AffectLife Satisfaction
Self-Compassion
Self-Coldness
Self-Warmth
Dysfunctional
Attitudes

T1 M (SD)T2 M (SD)T3 M (SD)T4 M (SD)CMT Control CMT Control CMT Control CMT Control(n = 45) (n = 21) (n = 45) (n = 21) (n = 45) (n = 21) (n = 45) (n = 21)
36.64
30.14
31.37
28.90
30.53
32.09
28.02
30.95
(9.36)(9.76)(9.72)(8.62)(8.38)(9.54)(9.43) (12.47)
15.51
9.71
11.2
10.19
7.51
11.04
7.95
12.09
(10.43) (9.25)(8.79)(6.86)(6.70)(8.52)(7.77)(8.25)
16.53
16.57
15.11
14.00
11.82
14.19
10.13
13.52
(8.74) (11.59) (9.32) (11.91) (7.97) (12.61) (7.83) (12.13)
24.4
16.76
20.75
19.14
18.93
20.66
15.77
19.14
(8.41)(7.68)(8.99) (10.89) (10.05) (11.52) (8.23) (10.66)
13.95
14.52
14.51
14.85
14.40
14.14
15.17
14.19
(2.13)(3.29)(2.62)(2.30)(2.60)(2.63)(2.48)(3.85)
26.00
26.80
24.84
26.23
25.04
24.14
27.02
24.95
(5.58)(4.42)(4.91)(5.30)(5.83)(7.09)(5.12)(6.05)
24.4
25.90
24.55
25.47
25.26
25.42
25.86
25.42
(8.41)(6.01)(5.57)(5.83)(5.70)(4.92)(6.12)(4.92)
2.82
3.07
3.19
3.05
3.50
3.13
3.43
3.11
(.55)
(.69)
(.65)
(.60)
(.50)
(.58)
(.61)
(.77)
3.68
3.11
3.22
3.19
2.93
3.00
2.92
3.11
(.68)
(.85)
(.72)
(.73)
(.72)
(.65)
(.74)
(.82)
3.33
3.26
3.60
3.30
3.94
3.26
3.79
3.34
(.64)
(.76)
(.72)
(.59)
(.51)
(.63)
(.68)
(.85)
-8.88
-3.90
-12.42-6.61-21.35-6.57-20.13-3.95(13.83) (17.70) (15.05) (16.26) (14.76) (19.74) (14.09) (21.06)

During the initial assessment, no differences were found between
individuals who successfully responded to the questionnaires (n = 66) and those who
did not (n = 58) across any of the variables measured at all time points. However,upon examining the distinctions in baseline characteristics between the CMT groupand the control group, notable discrepancies emerged in four variables. Specifically,
the CMT group reported higher levels of negative affect (moderate difference),
depression (moderate difference), stress (large difference), and self-coldness(medium to large difference) compared to participants in the control group.
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Therefore, regarding negative affect, depression, stress, and self-coldness mixedmodel ANCOVA tests were performed, in order to control the baseline differences
between the two groups (variables measured at baseline were introduced in ourmodels as a covariates). Conversely, no significant differences between the twogroups were observed in other measured variables such as anxiety, soothing positive
affect, activating positive affect, life satisfaction, self-compassion, self-warmth, anddysfunctional attitudes (refer to Table 3), therefore in these cases, mixed ANOVA
tests were performed.
Table 3. Differences in measured variables between CMT and control groups at baseline

Variable
Age
Negative AffectDepression
Anxiety
StressSoothing Positive Affect
Activating Positive AffectLife Satisfaction
Self-Compassion
Self-Coldness
Self-Warmth
Dysfunctional Attitudes

CMT Group(n = 45)

Control Group (n = 21)

M

SD

M

20.17
36.64
15.51
16.53
24.4
13.95
26.00
24.4
2.82
3.68
3.33
-8.88

1.54
9.36
10.43
8.74
8.41
2.13
5.58
8.41
.55
.68
.64
13.83

20.09
30.14
9.71
16.57
16.76
14.52
26.80
25.90
3.07
3.11
3.26
-3.90

t(64)

p

Cohen’s d

SD
.76
.23
9.76 2.59
9.25 2.17
11.59 -.01
7.68 3.52
3.29 -.72
4.42 -.58
6.01 -.99.69 -1.59.85 2.89.76.35
17.70 -1.24

.81
.01
.03
.98
.001
.47
.56
.32
.11
.005
.72
.218

.06
.67
.58
.003
.94
.20
.15
.20
.40
.74
.09
.31

Effectiveness of the intervention on primary outcomesWe first tested the effects on the primary outcomes, negative and soothing
positive affect. Regarding negative affect (see Figure 2), a mixed-model ANCOVA
test was performed, in order to control the baseline differences between the twogroups (negative affect measured at baseline was introduced in our model as acovariate). Mauchly's test of sphericity yielded a significant result, prompting thepresentation of time and time-group interaction effects with Huynh-Feldt correction(Epsilon for Greenhouse-Geisser = .83; Epsilon for Huynh-Feldt = .88). The time
had no effect on negative affect, F(1,76) = .726, p = .47, ηp² = .011, (nor when we
examined independently within each group), but the interaction between time andgroup had significant effect on it, F(1,76) = 3.21, p = .05, ηp² = .048. The groupeffect on negative affect was also significant, F(1) = 4.91, p = .03, ηp² = .072.

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Sidak pairwise comparisons indicated significant large difference between
the CMT (Mestimated= 29.48; SE = 1.11) and the control group (Mestimated = 34.34;
SE = 1.66) at post-test (Mdiff = 4.86, SE = 2.04, p =.02, d = .82). The differences
between the CMT (Mestimated = 26.84; SE = 1.37) and the control group(Mestimated = 33.47; SE = 2.04) was also significant and large at 3-months follow-up(Mdiff = 6.63, SE = 2.51, p =.01, d = .94).

Figure 2. Results for Negative Affect with Estimated Marginal Means
Notes. Covariates appearing in the model are evaluated at the following values: T1NegativeAffect = 34.57

Concerning soothing positive affect, Mauchly’s test of sphericity yieldedsignificance as well, necessitating the application of Huynh-Feldt correction forreporting time and time- group effects (Epsilon for Greenhouse-Geisser = .89;
Epsilon for Huynh-Feldt = .95). However, no significant effect emerged for soothing
positive affect.
In terms of the levels of soothing positive affect, no intergroup differenceswere apparent across any of the time points. However, when examined
independently within each group, multivariate tests revealed that the impact of time
on soothing positive affect was present exclusively in the CMT group, Wilk’s
λ = .87, F(3) = 2.84, p = .04, ηp² = .12, representing a medium to large effect, while
the control group did not exhibit this effect, Wilk’s λ = .96, F(3) = .79, p = .49,
ηp² = .03. The illustrated pattern of results is depicted in Figure 3 as well.

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Figure 3. Results for Soothing Positive Affect

Pairwise comparations revealed notable differences with a medium effectsize within the CMT group regarding levels of soothing positive affect, showcasing
a significant difference between baseline (M = 13.95, SD = 2.13) and follow-up(M = 15.17, SD = 2.48; Mdiff = 1.22, SE = .43, p = .04, d = .52) assessments.
Effectiveness of the intervention on secondary outcomes
Regarding depression, a mixed-model ANCOVA test was performed, inorder to control the baseline differences between the two groups (depression
measured at baseline was introduced in our model as a covariate). In terms ofdepression, Mauchly’s test of sphericity did not yield a significant result (p = .63),
implying that sphericity could be assumed.
We found significant effect of group on depression, F(1) = 7.89, p < .01,
ηp² = .11. However, no significant effect emerged for the time, F(2) = .358, p = .70,
ηp² = .006, nor for the time and group interaction, F(2) = 2.18, p = .11, ηp² = .03.
When examined independently within each group, multivariate tests revealed thatthe impact of time on depression was present exclusively in the CMT group, wherea reduction in depression was observed from mid-test (Mestimated = 10.49, SE = 1.10)
to post-test (Mestimated = 7.18, SE = 1.08, Mdiff = -3.30, SE = 1.29, p = .039), andmaintaining stability through the follow-up period (Mestimated = 7.32, SE = 1.08,
Mdiff = .13, SE = 1.27, p = .99). Depression levels within the control group remained
consistent across all time points. Regarding depression levels, significant differences
emerged between groups at the post-test with medium effect size (Mdiff = 4.54,
SE = 1.96, p < .05, d = .66) and at the follow-up with a large effect size (Mdiff = 6.13,

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SE = 1.96, p < .01, d = .99). The illustrated pattern of results is depicted in Figure 4
as well.

Figure 4. Results for Depression with Estimated Marginal Means
Notes. Covariates appearing in the model are evaluated at the following values: T1Depression = 13.66

Concerning anxiety, the assumption of sphericity was justified based on thenon- significant outcome of Mauchly’s test (p = .49). A significant medium effectattributed to time was identified in relation to anxiety, F(3) = 5.75, p < .01, ηp² = .08.
However, neither the group variable, F(1) = .30, p = .58, ηp² = .01, nor theinteraction between time and group exhibited an effect, F(3) = 1.47, p = .22,
ηp² = .02.
No differences emerged between the two groups at any of the time points.
However, upon analysing separately the change in anxiety amongst the individual
groups, a significant change of large effect size was observed exclusively within the
CMT group, denoted by Wilk’s λ = .28, F(3) = 8.02, p < .01, ηp² = .28, whereas nosuch change was apparent in the control group, Wilk’s λ = .95, F(3) = 1.04, p = .38,
ηp² = .05. Within the CMT group, anxiety levels remained consistent from baseline(M = 16.53, SD = 8.74) to mid-test (M = 15.11, SD = 9.32, Mdiff = -1.42, SE = 1.27,
p =.84), but decreased from baseline to post-test (M = 11.82, SD = 7.97, Mdiff = 4.71, SE = 1.41, p < .01, d = .37), and remained unchanged from post-test to followup (M = 10.13, SD = 7.83, Mdiff = -1.68, SE = 1.29, p = 73). Results for anxiety arealso presented in Figure 5.

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Figure 5. Results for Anxiety

Regarding stress, a mixed-model ANCOVA test was performed, in order tocontrol the baseline differences between the two groups (stress measured at baseline
was introduced in our model as a covariate). Due to the significant outcome ofMauchly’s test (p = .015), it was not appropriate to assume sphericity. Consequently,
we reported both time and time*group interaction effects with the Huynh-Feldt
correction (Epsilon for Greenhouse-Geisser = .88; Epsilon for Huynh-Feldt = .94).
No significant time, F(1,88) = .46, p = .61, ηp² = .007, nor time and group interaction
effect, F(1,88) = 1.79, p = .17, ηp² = .10, were found on stress. However, the group
had significant effect on stress, F(1) = 9.27, p < .01, ηp² = .128.
Regarding stress, controlled for the initial stress levels, significant large
differences emerged between groups at the post-test (Mdiff = 6.92, SE = 2.60,
p = .01, d = .94) and also at the follow-up (Mdiff = 7.40, SE = 2.31, p < .01,
d = 1.15). Examining the effect of time on stress independently within each group,
multivariate tests revealed that the impact of time on stress was present exclusively
in the CMT group, Wilk’s λ = .86, F(2) = 4.75, p = .01, ηp² = .13, representing a
medium to large effect, while the control group did not exhibit this effect, Wilk’s
λ = .85, F(2) = .85, p = .43, ηp² = .027. These results mean that stress levels within
the control group remained consistent across all time points. However, noteworthychanges occurred within the CMT group, where a reduction in stress was observed
from mid-test (Mestimated = 19.45, SE = 1.32) to the follow-up period(Mestimated = 14.49, SE = 1.23, Mdiff = 4.96, SE = 1.64, p = .01). Results are presented
in Figure 6 as well.

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Figure 6. Results for Stress with Estimated Marginal Means
Notes. Covariates appearing in the model are evaluated at the following values: T1Stress = 21.96

Given the non-assumption of sphericity for activating positive affect(p = .02), we proceeded to report time and time*group effects employing the HuynhFeldt correction (Epsilon for Greenhouse-Geisser = .87; Epsilon for HuynhFeldt = .93 However, neither of the effects exhibited significance for activating
positive affect: this includes the time effect, F(2,79) = 2.38, p = .07, ηp2 = .03, thetime and group interaction, F(2,79) = 2.49, p = .06, ηp2 = .037, as well as the groupeffect, F(1) = .02, p = .87, ηp2 = .00
Analyzing the changes across time separately for the two groups, we founda significant and large time effect for the CMT group, Wilk’s λ = .86, F(3) = 3.29,
p = .02, ηp2 = .13, contrasting with the control group, where no such effect emerged,
Wilk’s λ = .90, F(3) = 2.06, p = .11, ηp2 = .09 (see also Figure 7). Within the CMT
group, the sole significant difference occurred between the mid-test measurement(M = 24.84, SD = 4.91) and follow-up measurement (M = 27.02, SD = 5.12,
Mdiff = 2.17, SE = .71, p = .02, d = .43). No differences were found between thegroups at any time point.

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Figure 7. Results for Activating Positive AffectConcerning life satisfaction, given the non-significant outcome ofMauchly’s test (p = .08), we proceeded with the assumption of sphericity. Our
analysis indicated the absence of a time effect, F(3) = 1.52, p = .20, ηp² = .02, nointeraction effect between time and group was detected, F(3) = .69, p = .55,
ηp² = .01, and no group effect was identified, F(3) = .29, p = .59, ηp² = .01.
No differences were found between groups in any of the time points, andtime effects remained non-significant even when analyzed separately for each of thetwo groups.
Effectiveness of the intervention on investigated mechanisms
We also tested the effectiveness of the intervention on possible mechanisms(self- compassion, self-coldness, self-warmth, and dysfunctional attitudes).
Regarding self- compassion, based on Mauchly’s non-significant test results(p = .16), sphericity was assumed. We found a significant and large time effect,F(3) = 11.59, p < .01, ηp2 = .15, a significant and medium time and group interaction
effect, F(3) = 8.27, p < .01, ηp2 = .11, but no significant group effect, F(1) = 1.08,
p = .30, ηp2 = .01.
Multivariate analyses indicated a significant time effect with a large effectsize exclusively in the CMT group, Wilk’s λ = .37, F(3) = 34.69, p < .01, ηp2 = .62,
whereas no such effect was observed in the control group, Wilk’s λ = .98, F(3) = .23,
p = .87, ηp2 = .01. In the control group, self-compassion levels remained consistentacross all time points Conversely, students in the CMT group experienced anincrease in self-compassion levels from baseline (M = 2.82, SD = .55) to the mid88

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test (M = 3.19, SD = .65, Mdiff = .37, SE = .08, p < .01, d = .61). This upward trend
continued from the mid-test to the post-test (M = 3.5, SD = .50, Mdiff = .31, SE = .07,
p < .01, d = .53), and these levels remained stable from the post-test to the followup (M = 3.43, SD = .61, Mdiff = -,07, SE = .07, p = .91). A difference in selfcompassion emerged between the two groups during the post-test (Mdiff = .375,
SE = .140, p < .01, d =.68), However, these differences were no longer significant
at the follow-up assessment (Mdiff = .314, SE = .176, p = .08, d = .46). For theseresults, see also Figure 8.

Figure 8. Results for Self-Compassion

The results for self-warmth were similar to the results for self-compassion(see Figure 9). Mauchly's sphericity test did not produce a significant result(Mauschly’s W = .91, df = 5, p = .34), indicating that we could assume sphericity.
Significant medium effects were observed for time, F(3) = 6.43, p < .01, ηp2 = .09,
the interaction of time and group, F(3) = 5.77, p < .01, ηp2 = .08, and group,
F(1) = 6.18, p = .01, ηp2 = .08.
Regarding self-warmth levels, large significant differences emerged
between groups at the post-test (Mdiff = .68, SE = .14, p < .01, d = 1.18), andmedium divergences were observed at follow-up (Mdiff = .44, SE = .19, p = .02, d=.58). For participants in the control group, self- warmth remained constant acrossthe four measurement time points, with time having no effect (Wilk’s λ = .98,
F(3) = .23, p = .87, ηp2 = .01), as opposed the CMT group, where a significant large
time effect was found (Wilk’s λ = .48, F(3) = 22.02, p < .01, ηp2 = .51). The patternof change mirrored that of self-compassion, with self-warmth increasing frombaseline (M = 3.33, SD = .64) to the mid-test (M = 3.60, SD = .72, Mdiff = .27,
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SE = .09, p = .03, d = .39), continuing to increase from mid-test to post-test(M = 3.94, SD = .51, Mdiff = .33, SE = .08, p < .01, d = .54), and remaining stablethrough follow-up (M = 3.79, SD = .68, Mdiff = -.14, SE = .08, p = .36).

Figure 9. Results for Self-Warmth

Regarding self-coldness, a mixed-model ANCOVA test was performed, inorder to control the baseline differences between the two groups (self-coldness
measured at baseline was introduced in our model as a covariate). For self-coldness
the sphericity was assumed (Mauschly’s W = .92, df = 2, p = .07). We found asignificant time effect, F(2) = 3.30, p = .04, ηp2 = .05, but no time and groupinteraction effect was identified, F(2) = 1.97, p = .14, ηp2 = .03. The group effect
was also significant, F(1) = 7.93, p < .01, ηp2 = .112 (see also Figure 10).
Examining the effect of time on self-coldness independently within eachgroup, multivariate tests revealed that the impact of time on self-coldness waspresent exclusively in the CMT group, Wilk’s λ = .79, F(2) = 8.01, p = .001,
ηp² = .20, representing a large effect, while the control group did not exhibit thiseffect, Wilk’s λ = .95, F(2) = 1.46, p = .24, ηp² = .04. These results mean that selfcoldness levels within the control group remained consistent across all time points.
However, noteworthy changes occurred within the CMT group, where a reduction
in self-coldness was observed from mid-test (Mestimated = 3.13, SE = .09) to post-test(Mestimated = 2.84, SE = .09, Mdiff = -.29, SE = .08, p = .001), and maintaining

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stability through the follow-up period (Mestimated = 2.80, SE = .08, Mdiff = .03,
SE = .09, p = .97).

Figure 10. Results for Self-Coldness with Estimated Marginal Means
Notes. Covariates appearing in the model are evaluated at the following values: T1Self-Coldness = 3.50

Regarding self-coldness, controlled for the initial self-coldness levels,
significant differences emerged between groups at the post-test with a medium effectsize (Mdiff = .359, SE = .168, p = .037, d = .59) and at the follow-up we found large
differences (Mdiff = .574, SE = .163, p < .01, d = .97).
Last, we examined the impact on dysfunctional attitudes, the results of which
are presented in Figure 11. Sphericity was not assumed for dysfunctional attitudes(Mauschly’s W = .79, df = 5, p = .01) facilitating the report of time and time*groupeffects utilising the Huynh- Feldt correction (Epsilon for Greenhouse-Geisser = .87,
Epsilon for Huynh-Feldt = .93). Significant medium-sized effects were identified,including time effect, F(2,79) = 6.89, p < .01, ηp2 = .09, time and group interaction
effect, F(2,79) = 5.52, p < .01, ηp2 =.07, as well as group effect, F(1) = 8.34, p < .01,
ηp2 = .11.

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Figure 11. Results for Dysfunctional Attitudes

Pairwise comparations revealed significant and large differences indysfunctional attitudes during the post-test (Mdiff = 14.78, SE = 4.35, p < .01,
d = .84), and follow-up (Mdiff = 16.18, SE = 4.38, p < .01, d = .90) assessments.
Large-scale time effects were also observed solely within the CMT group, Wilk’s
λ = .56, F(3) = 16.12, p < .01, ηp2 = .43, while no such effects were noticed in thecontrol group, Wilk’s λ = .97, F(3) = .55, p = .64, ηp2 = .02.
The levels of dysfunctional attitudes for participants belonging to the CMT
group remained consistent from baseline (M = -8.88, SD = 13.83) to mid-test (M = 12.42, SD = 15.05, Mdiff = -3.53, SE = 1.89, p = .33), decreased from mid-test to
post-test (M = -21.35, SD = 14.76, Mdiff = -8.93, SE = 1.53, p < .01, d = .59), andmaintained stability from post-test to follow-up (M = -20.13, SD = 14.09,
Mdiff = 1.22, SE = 1.87, p = .98).
Testing of mechanisms of the intervention on negative affect
For testing the longitudinal mediation effects, we tested indirect effects
based on the model presented in Figure 12. Given that we found baseline differences
between groups, we also controlled for the effect of the group on variables at thebaseline level. Based on Goldsmith and colleagues' (2018) recommendations, we
additionally controlled for contemporaneous covariance between mediator andoutcome.

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Figure 12. Tested model for longitudinal mediation analyses

The effect of the group on primary outcomes (negative affect and soothing
positive affect) was examined through the hypothesized mediators: self-compassion,
self-coldness, self- warmth, and dysfunctional attitudes. In Figure 13, we havedisplayed the specific indirect effects that were of particular interest to us.

Figure 13. Tested indirect effects

Our initial analysis focused on examining the longitudinal indirect effects
on negative affect. The results indicate that the standardized indirect effect of thegroup on negative affect, as measured through indirect paths, was not statisticallysignificant. The detailed results can be found in Table 4.

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Table 4 Standardized indirect effects on negative affectPredictor
Mediator
Group
T2Self-compassion
Group
T3Self-compassion
Group
T2Self-coldnessGroup
T3Self-coldnessGroup
T2Self-warmthGroup
T3Self-warmthGroup
T2Dysfunctional Attitudes
Group
T3Dysfunctional Attitudes

EffectStandardized
type
OutcomeIndirect Effects
Indirect T3NegativeA-.06
Indirect T4NegativeA.10
Indirect T3NegativeA-.07
Indirect T4NegativeA.05
Indirect T3NegativeA-.08
Indirect T4NegativeA.07
Indirect T3NegativeA-.06
Indirect T4NegativeA.06

95% CI
LL
UL
-.22
.09
-.06
.28
-.22
.08
-.11
.21
-.24
.07
-.09
.26
-.23
.11
-.12
.24

Notes: ** The regression is significant at the .01 level; CI Confidence Interval; LL Lower Limit; UL Upper
Limit; NegativeA Negative Affect

These results indicate that self-compassion levels assessed during midintervention did not mediate the effect of the group towards the volume of negative
affect measured at post-test (ß = -.06, 95%CI = -.22 to .09). Moreover, selfcompassion levels assessed during post-test did not mediate the effect of the group
towards the degree of negative affect measured at the three- month follow-up(ß = .10, 95%CI = -.06 to .28).
Additionally, when examined, the separate mediating effects of selfcoldness and self- warmth indicate that neither self-coldness at mid-intervention(ß = -.07, 95%CI = -.22 to .08) nor self-coldness at post-test (ß = .05, 95%CI = -.11
to .21) served as significant mediators of the effects. Likewise, self-warmth at midintervention (ß = -.08, 95%CI = -.24 to .07) and self- warmth at post-test (ß = .07,
95%CI = -.09 to .26) did not emerge as significant mediators. Furthermore,
dysfunctional attitudes did not exhibit a significant mediating effect at either the midtest (ß = -.06, 95%CI = -.23 to .11) or the post-test (ß = .06, 95%CI = -.11 to .24).
Testing of mechanisms of the intervention on soothing positive affectWe also analyzed the longitudinal indirect effects on soothing positive
affect. The results, which can be found in Table 5, indicate that, in the majority ofcases, the standardized indirect effect of the group on soothing positive affectthrough the indirect paths was not statistically significant.
Table 5 Standardized Indirect Effects of the Group on Soothing Positive AffectPredictor
Mediator
Group
T2Self-compassion
Group
T3Self-compassion
Group
T2Self-coldness

94

Effecttype
Indirect
Indirect
Indirect

Standardized
OutcomeIndirect Effects
T3SoothingPA.04
T4SoothingPA-.11
T3SoothingPA.04

95% CI
LL
UL
-.10
.17
-.25
.01
-.11
.17

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Predictor
Mediator
Group
T3Self-coldnessGroup
T2Self-warmthGroup
T3Self-warmthGroup
T2Dysfunctional Attitudes
Group
T3Dysfunctional Attitudes

Effecttype
Indirect
Indirect
Indirect
Indirect
Indirect

Standardized
OutcomeIndirect Effects
T4SoothingPA-.02
T3SoothingPA.06
T4SoothingPA-.14
T3SoothingPA.06
T4SoothingPA-.14

95% CI
LL
UL
-.16
.08
-.09
.20
-.31
.03
-.09
.21
-.29 -.004

Notes: ** The regression is significant at the .01 level; CI Confidence Interval; LL Lower Limit; UL Upper
Limit; SoothingPA Soothing Positive Affect

The findings regarding soothing positive affect showed that self-compassion
at mid- intervention did not mediate the group's effect on soothing positive affect at
post-test (ß = .04, 95%CI = -.10 to .17). Similarly, self-compassion at post-test did
not mediate the group's effect on soothing positive affect at the three-month followup (ß = -.11, 95%CI = -.25 to .01)
While examining the mediating effects of self-coldness and self-warmth
separately, the results revealed that neither self-coldness at mid-intervention(ß = .04, 95%CI = -.11 to .17) nor self-coldness at post-test (ß = -.02, 95%CI = -.16
to .08) served as significant mediators. Likewise, self-warmth at mid-intervention(ß = .06, 95%CI = -.09 to .20) and self-warmth at post-test (ß = -.14, 95%CI = -.310
to .03) did not demonstrate significant mediation effects.
Although no significant mediating effect was found for dysfunctional
attitudes at the mid-test (ß = .06, 95%CI = -.09 to .21), it was revealed thatdysfunctional attitudes measured at the post-test mediated the effect of the group on
soothing positive affect at the three-month follow-up (ß = -.14, 95%CI = -.29 to .004). This suggests that the group's influence on soothing positive affect, asmeasured at the follow-up, may be partially explained by dysfunctional attitudes
measured at the post-test within an academic setting.

Discussion
The effectiveness of the intervention on primary outcomes
The current study aimed to assess the effectiveness of the Hungarian
adaptation of Compassion Mind Training in a pragmatic trial conducted within an
academic setting, targeting undergraduate students’ distress and well-being. We
focused on assessing its impact on two key outcomes: negative affect and soothing
positive affect. In line with previous findings (Beaumont et al., 2021; Irons & HeriotMaitland, 2021; Matos et al., 2017; Matos et al., 2022), our results demonstrate theintervention's effectiveness in improving affect. Regarding negative affect, a mixedmodel ANCOVA test was performed, in order to control the baseline differences
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between the two groups. We found large differences between the CMT and the control
group at post-test and also at 3-months follow-up. Furthermore, we identified a
medium to large effect of time towards soothing positive affect for participants
belonging to the CMT group. However, it's noteworthy that we did not find significant
differences between the intervention and control groups at any of the assessment time
points. This may be attributed, in part, to limitations in statistical power.
Taking these outcomes into account, our first hypothesis was partiallyconfirmed. We originally anticipated that students in the intervention group would
report lower levels of negative affect and higher levels of soothing positive affectcompared to the control group following the intervention. However, we foundsignificant differences between the two groups at post-test and at follow-up only for
negative affect.
The effectiveness of the intervention on secondary outcomes
As expected, our results underscore the effectiveness of this intervention in
addressing secondary outcomes, particularly those related to indicators of distress,
such as depression, anxiety, and stress. However, the results for well-being markers,
specifically activating positive affect and life satisfaction, seem less promising
compared to the distress indicators.
At the outset of our study, we identified baseline differences in depression
and stress levels, with psychology students reporting higher scores than their peers
in other fields of study. Therefore, regarding depression and stress, mixed-model
ANCOVA tests were performed, in order to control the baseline differences between
the two groups (depression and stress measured at baseline were introduced in ourmodels as covariates). As expected, regarding both, depression and stress levels,
significant differences emerged between groups at the post- test and at the followup. Examining the effect of time on depression and stress independently within eachgroup, multivariate tests revealed that the impact of time on depression and stress
was present exclusively in the CMT group. Also, concerning anxiety, a significant
time effect emerged solely within the CMT group, indicating a reduction in anxiety
levels from baseline to post-test, which persisted through the follow-up assessment.
In terms of activating positive affect and life satisfaction, our analysis did
not reveal any noteworthy effects related to time, group, or their interaction.
Furthermore, group disparities and temporal variations were absent in thesemeasures as well.
In light of these outcomes, it seems that the intervention's primary benefits
lie in reducing distress levels, encompassing negative affect, depression, anxiety, andstress. Its impact on cultivating overall well-being, including soothing positive
affect, activating positive affect, and life satisfaction, appears to be less pronounced.
Furthermore, these results reinforce the significance of distinguishing between
soothing and activating positive affect, based on Gilbert’s theory (2009a, 2009b,
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2014, Gilbert et al., 2008). Additionally, our findings align with prior research
indicating that compassionate mind training mainly enhances soothing positive
affect, with non-significant effects on activating positive affect (Matos et al., 2017).
The effectiveness of the intervention on investigated mechanisms
Anticipations included the intervention's effectiveness in fostering selfcompassion and self-warmth, alongside a reduction in self-coldness anddysfunctional attitudes. Our findings support these expectations, as we identified
significant differences between the two groups in self-compassion, self-warmth,
self-coldness (after controlling for the baseline differences), and dysfunctional
attitudes at the post-test, with the differences in self-warmth, self-coldness, anddysfunctional attitudes persisting through the follow-up.
Additionally, significant time effects solely within the CMT group, with nosuch effects seen in the control group. Within the control group, measures of selfcompassion, self-warmth, self-coldness, and dysfunctional attitudes remained
constant across all assessment time points. For participants within the CMT group,
both self-compassion and self-warmth levels increased from baseline to post-test andremained stable through the follow-up assessment. The impact of time on selfcoldness was also present exclusively in the CMT group. Comparatively, the CMT
group exhibited a decline in dysfunctional attitudes from baseline to post-test, andthese improvements remained steady during the follow-up period.
Taken together, these outcomes underscore the intervention's effectivenessin altering the mechanisms under investigation, successfully nurturing selfcompassion and self-warmth, while concurrently mitigating self-coldness anddysfunctional attitudes.
The longitudinal mediation role of the supposed mechanisms
Prior research (Irons & Heriot-Maitland, 2021; Matos et al., 2022) has
suggested that self-compassion serves as the primary mechanism of change within the
CMT intervention. However, these studies have mainly relied on cross-sectional
analyses, which may introduce bias due to an inability to account for the autoregressive
nature of the data. Therefore, based on recommendations (Goldsmith et al., 2018;
Maxwell et al., 2011) this study conducted longitudinal mediation analyses, examining
the role of self-compassion on the clinical benefits of the intervention concerning
primary outcomes, namely, negative and soothing positive affect.
Intriguingly, our findings diverge from prior expectations, revealing nolongitudinal mediating effect for self-compassion. Building on Compassion-Focused
Therapy's theoretical framework (Gilbert, 2009a, 2009b, 2014) and corroborative
insights from meta-analyses (Chio et al., 2021; Muris and Petrocchi, 2016), whichhighlight the important distinction between self-warmth (positive dimensions of selfCompassionate Mind Training for Students

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compassion, compassionate behaviors) and self- coldness (negative dimensions ofself-compassion, uncompassionate behaviors), we tested the individual mediation
roles of self-warmth and self-coldness but found no significant longitudinal
mediating effects. The longitudinal mediation analyses conducted in our study did
not support self-compassion as a mechanism of change. However, it is worth notingthat the small sample size may constrain our ability to detect such effects, potentiallyleading to false negative errors.
Furthermore, we undertook an exploratory assessment regarding thelongitudinal mediating impact of dysfunctional attitudes on negative affect andsoothing positive affect. The findings revealed no significant indirect effect on
negative affect, yet a notable mediation effect emerged for post-test dysfunctional
attitudes influencing follow-up soothing positive affect. These results imply that theintervention's elevation of soothing positive affect during follow- up is driven by theattenuation of dysfunctional attitudes measured at the post-test. This reinforces the
crucial role dysfunctional attitudes play in students' overall well-being. In light ofthese findings, it appears that students may experience an enhanced sense of safety
and contentment when their levels of typical dysfunctional beliefs (Weissman &Beck, 1978) are diminished.
Limits and future directions
Despite our encouraging results on the effectiveness of the CMTintervention in promoting students’ well-being and reducing their distress, we mustalso consider a number of limitations of our study. A primary limitation revolves
around the non-randomized allocation of participants to groups, resulting insignificant disparities in baseline values across various measured variables.
Consequently, it is imperative to advocate for further research, particularly
randomized controlled trials, which represent the gold standard for effect assessment(David, 2012)
Another substantial limitation pertains to our study's modest sample size andthe subsequent lack of statistical power, particularly when making inter-groupcomparisons at individual time points. The reliability of our results may also be
influenced by the high attrition rate, primarily within the control group. To mitigate
dropout rates and for other methodological reasons, future investigations should
consider implementing active control groups to assess the effectiveness ofCompassionate Mind Training on students' distress and well-being. An intriguing
avenue for exploration could involve measuring and comparing the relative
effectiveness of Compassionate Mind Training (Irons & Heriot-Maitland, 2021),
based on Gilbert’s (2009a, 2009b, 2014) theoretical framework and practices, against
the Mindful-Self Compassion (MSC) program (Neff & Germer, 2012), which hinges
on Neff's (2003a) conceptualization of self-compassion and its associatedinterventions.
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Our study solely relied on self-reported measures to investigate theintervention's effectiveness. Nevertheless, future explorations should consider
incorporating objective outcomes, such as Heart Rate Variability (HRV), as anindicator of intervention impact, in order to enhance robustness. Prior findings(Matos et al., 2017) have suggested that CMT can positively influence HRV, aphysiological marker of well-being. Although it is also a subjective instrument, thevalidity of our research would be greatly enhanced if we used an EcologicalMomentary Assessment (EMA) app such as the MoodWheel to measure emotional
well-being and distress, which according to current results is an excellent tool forassessing students’ emotions (Tomoioagă et al., 2024). Finally, our intervention
group comprised solely Psychology students, warranting further assessments
encompassing students from diverse majors to ensure more comprehensive andgeneralizable conclusions.
Authors’ Notes
Acknowledgement. This manuscript is original, has not been published
before, and is not currently considered for publication elsewhere.
Conflict of Interest. No conflict of interest is associated with thispublication, and there has been no financial support for this work that could haveinfluenced its outcome.
Publication Ethics. The study was undertaken in accordance with the Codeof Ethics of the American Psychological Association.
Authorship. All authors have substantial scientific contributions inorganizing and conducting the analysis, in interpreting the results and findings, andall authors reviewed the manuscript and agreed on responsibility for its content.

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