BasedownE 2020 MCLIN

Running head: RESEARCH PROJECT i
Effects of the Mindful Self-Compassion Program
on Shame and Psychological Wellbeing: A Pilot Study
This report is submitted in partial fulfillment of the degree of

Master of Psychology (Clinical)
School of Psychology
University of Adelaide
October 2020
Word Count
Literature Review: 4022
Journal Article: 7720
RESEARCH PROJECT ii
DECLARATION
This report contains no material which has been accepted for the award of any other degree
or diploma in any University, and, to the best of my knowledge, this report contains no
materials previously published except where due reference is made.
I give permission for the digital version of my thesis to be made available on the web, via the
University’s digital research repository, the Library Search and also through web search
engines, unless permission has been granted by the School to restrict access for a period of
time.
October 2020
RESEARCH PROJECT iii
Table of Contents
Acknowledgements .................................................................................................................... v
Literature Review....................................................................................................................... 1
The Mindful Self-Compassion Program: Rationale, Current Research and Future
Directions ............................................................................................................................... 1
Abstract .................................................................................................................................. 2
Rationale of the Mindful Self-Compassion Program............................................................. 3
Mindfulness and Mindfulness Based Programs ................................................................. 3
Self-Compassion and Cultivating Self-Compassion .......................................................... 5
The Mindful Self-Compassion Program ................................................................................ 7
Research Investigating the Mindful Self-Compassion Program ........................................ 8
Limitations and Future Directions ....................................................................................... 11
The Mindful Self-Compassion Program and Shame ....................................................... 11
The Mindful Self-Compassion Program Modalities ........................................................ 13
The Mindful Self-Compassion Program and Mindfulness-Based Programs ................... 14
Other Considerations for Future Research into the Mindful Self Compassion Program 15
Conclusion ........................................................................................................................... 15
References ............................................................................................................................ 17
Journal Article .......................................................................................................................... 24
Effects of the Mindful Self-Compassion Program on Shame and Psychological Wellbeing:
A Pilot Study ........................................................................................................................ 25
Abstract ................................................................................................................................ 26
Introduction .......................................................................................................................... 27
The Present Study: Aims and Hypotheses ....................................................................... 32
Methods................................................................................................................................ 34
Participants ....................................................................................................................... 34
Measures .......................................................................................................................... 34
Procedure ......................................................................................................................... 37
Intervention ...................................................................................................................... 38
Results .................................................................................................................................. 38
Descriptive Analyses ....................................................................................................... 40
Intervention Outcomes ..................................................................................................... 41
Discussion ............................................................................................................................ 45
Overview of Findings ...................................................................................................... 45
The Mindful Self-Compassion Program and Shame ....................................................... 47
The Intensive Mindful Self-Compassion Program and Measures of Wellbeing ............. 49
The Online Mindful Self-Compassion Program and Measures of Wellbeing ................. 50
RESEARCH PROJECT iv
Limitations and Future Research ..................................................................................... 51

Conclusion ....................................................................................................................... 53
References ............................................................................................................................ 54
Appendix A .......................................................................................................................... 61
Appendix B .......................................................................................................................... 62
Tables ................................................................................................................................... 63
Instructions to Authors for the Journal of Clinical Psychology ............................................... 63
RESEARCH PROJECT v
Acknowledgements
Firstly, I would like to thank my supervisor, Dr Michael Proeve. I am grateful for the
support and guidance Michael has provided, as well as his time and feedback. I would also
like to thank Tina Gibson, the facilitator of the Mindful Self Compassion Program. Earlier
this year, we were not sure if the program or research project could go ahead as a result of
COVID-19. I am thankful for Tina’s flexibility and commitment to running the Mindful Self-
Compassion Program. Finally, I would like to thank my family and friends for their endless
support, enthusiasm and encouragement.

Running head: THE MINDFUL SELF-COMPASSION PROGRAM 1
Literature Review
The Mindful Self-Compassion Program: Rationale, Current Research and Future Directions
The University of Adelaide
Word Count: 4022

THE MINDFUL SELF-COMPASSION PROGRAM 2
Abstract
This literature review aimed to provide an overview of the Mindful Self-Compassion
program, including the rationale for the program, research to date that has examined the
effectiveness of the program, and future directions for research on the program. Review of
the literature suggests there is a sound rationale for the MSC program. The MSC program
appears to be a feasible and acceptable intervention for enhancing self-compassion,
mindfulness and other measures of wellbeing. However, the field of literature examining the
effectiveness of the MSC program is limited. There are several areas for future research for
the MSC program, which are discussed.

Mindfulness-based interventions (MBIs) have been widely investigated, with findings
showing their beneficial effects on mental health outcomes (Hofmann, Sawyer, Witt, & Oh,
2010; Khoury, Sharma, Rush, & Fournier, 2015). Emerging evidence suggests that self-
compassion plays an important role in the beneficial effects of MBIs (Evans, Wyka, Blaha, &
Allen, 2018; Keng, Smoski, Robins, Ekblad, & Brantley, 2012; Kuyken et al., 2010; Sevel,
Finn, Smith, Ryden, & McKernan, 2020). Self-compassion is defined as a healthy attitude
toward the self and is conceptualised as including three components: self-kindness,
mindfulness and common humanity (Neff, 2003). Research shows that self-compassion is
positively associated with psychological wellbeing, and negatively associated with symptoms
of psychological disorders (MacBeth & Gumley, 2012; Zessin, Dichkäuser, & Garbade,
2015). The documented benefits of self-compassion and the literature that highlights the role
of self-compassion in the beneficial effects of MBIs, suggests that specifically focusing on
the cultivation of self-compassion may be beneficial to optimize therapeutic change. This
rationale led to the development of the Mindful Self-Compassion (MSC) program, a
manualised intervention designed specifically to help individuals cultivate self-compassion.
The aim of this literature review was to provide an overview of the rationale of the MSC
program, the research to date examining the effectiveness of the MSC program, and future
directions for research on the MSC program.
Rationale of the Mindful Self-Compassion Program
Mindfulness and Mindfulness Based Programs
Mindfulness is defined as focusing on the present moment without judgement (Kabat-
Zinn, 2003). MBIs, including Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn,
1990) and Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale,
2013), have been developed to help individuals practise and cultivate mindful awareness.
Research has widely investigated these MBIs and their effects on mental health. A meta-
analysis conducted by Hofmann et al. (2010) investigated the effect of mindfulness-based
therapy, including MBSR and MBCT, on anxiety and depressive symptoms in a range of
clinical conditions. Findings showed that mindfulness-based therapy was effective in
improving symptoms of anxiety and mood disorders with large effect sizes (Hofmann et al.,
2010). Mindfulness-based therapy was also shown to be moderately effective in improving
anxiety and depressive symptoms in other psychiatric and medical conditions (Hofmann et
al., 2010). Another meta-analysis investigated the effects of mindfulness-based therapy,
specifically MBSR, for nonclinical populations (Khoury et al., 2015). MBSR had a large
effect on stress, moderate effects on anxiety, depression, distress and quality of life, and a
small effect on burnout (Khoury et al., 2015). Findings showed that participation in MBSR
led to significant increases in mindfulness and compassion, and that these changes were
correlated with improvement in clinical outcomes (Khoury et al., 2015). These findings
highlight the effectiveness of MBIs as an intervention for improving mental health outcomes
in clinical and nonclinical populations.
Given the large evidence base supporting the effectiveness of MBIs, researchers have
examined the mechanisms by which these programs lead to improvements in mental health.
A systematic review using meta-analytic techniques revealed consistent evidence for
cognitive and emotional reactivity, mindfulness, rumination, and worry, as mechanisms
underlying the effects of MBIs (Gu, Strauss, Bond, & Cavanagh, 2015). Findings also
suggested preliminary evidence for self-compassion as a mechanism underlying the effects of
MBIs (Gu et al., 2015). It is important to note that most of the reviewed studies were
considered to have weaknesses in their methodology, and only a few studies had investigated
self-compassion as a mediator of the effects of MBIs on wellbeing (Gu et al., 2015). These
studies investigated the role of self-compassion in addition to mindfulness in the effects of
MBIs on wellbeing. The reviewed randomized controlled trials showed that both increases in
mindfulness and self-compassion mediated effects of MBIs on mental health outcomes (Keng
et al., 2012; Kuyken et al., 2010).
Recent studies have further examined the meditation effect of mindfulness and self-
compassion in the relationship between MBIs and mental health. These studies have aimed to
address the methodological and statistical limitations of previous studies (Gu et al., 2015;
Sevel et al., 2020). Evans et al. (2018) examined the relationship between mindfulness-based
therapy, self-compassion, mindfulness and mood. Evans et al. (2018) found a serial
mediation effect, whereby participation in mindfulness-based therapy led to increases in
mindfulness, which subsequently led to increases in self-compassion, and then improvements
in mood. The reverse model of mindfulness-based therapy leading to increases in self-
compassion, then mindfulness, and then subsequent improvements in mood, was not
significant (Evans et al., 2018). Sevel et al. (2020) also found self-compassion to mediate the
relationship between mindfulness-based therapy and psychological distress, both directly and
indirectly through mindfulness. Again, the reverse model of mindfulness-based therapy
leading to increases in self-compassion, then mindfulness, and then improvements in
psychological symptoms, was not significant (Sevel et al., 2020). These findings indicate that
mindfulness is important for the development of self-compassion, and that self-compassion
may play an important role in the beneficial effects of mindfulness-based programs on mental
health. However further research is needed to support these findings.
Self-Compassion and Cultivating Self-Compassion
Self-compassion is defined as a healthy attitude about the self and is conceptualised as
including three components: self-kindness, common humanity and mindfulness (Neff, 2003).
Self-kindness involves being kind, understanding and accepting of oneself in the midst of
suffering, instead of being self-critical; common humanity involves recognising and
acknowledging one’s experiences are part of being human, instead of feeling isolated;
mindfulness involves being aware of one’s thoughts and feelings, holding them in balanced
awareness instead of becoming over identified with them (Germer & Neff, 2019; Neff, 2003).
Germer and Neff (2019) provide a comprehensive review of self-compassion research, noting
that the literature on self-compassion is expanding exponentially. Meta-analyses show self-
compassion is positively associated with psychological wellbeing (Zessin et al., 2015), and
negatively associated with symptoms of psychological disorders with large effect sizes
(MacBeth & Gumley, 2012). In fact, self-compassion has been shown to be associated with
wellbeing across multiple domains, including psychopathology, psychological health,
emotional intelligence, self-concept, body image, motivation and interpersonal functioning
(Neff et al., 2018).
Based on the beneficial associations of self-compassion with wellbeing and
psychopathology, and the reviewed literature that highlights the role of self-compassion in
the beneficial effects of MBIs, specifically focusing on the cultivation of self-compassion
may be beneficial. However there appears to be debate in the literature, specifically in terms
of whether self-compassion should be taught implicitly or explicitly (Germer & Neff, 2019).
Self-compassion is taught implicitly in MBIs, with research showing participation in MBIs
leads to increases self-compassion (Evans et al., 2018; Gu et al., 2015; Proeve, Anton, &
Kenny, 2018; Sevel et al., 2020). Leaders in the mindfulness field state, for example, that
“nothing ever needed to be said explicitly” about self-compassion (Kabat-Zinn, 2005, p.
285), and “mindfulness and compassion are caught not taught” (Segal et al., 2013, p. 140)
(Germer & Neff, 2019). However, given the emerging evidence that self-compassion plays a
key role in the beneficial effects of MBIs, the question is raised as to whether self-
compassion should be taught explicitly in an intervention. Kazdin (2007) suggests that further
understanding the mechanisms of psychological interventions allows clinicians to optimise
therapeutic change. Therefore, if self-compassion does play a role in the effectiveness of

mindfulness-based programs, therapeutic change may be optimized by explicitly using and
teaching self-compassion practices.
The Mindful Self-Compassion Program
The Mindful Self-Compassion (MSC) program is a manualised and structured group
program developed by Christopher Germer and Kristin Neff (Germer & Neff, 2019; Neff &
Germer, 2013). The MSC program was designed specifically to enhance self-compassion
among members of the general public. However, the authors also acknowledge the important
role of mindfulness in self-compassion, describing the MSC program as a hybrid between
self-compassion and mindfulness (Germer & Neff, 2019). The rationale for the program
follows the extensive field of research documenting the benefits of self-compassion, and the
research highlighting the key role self-compassion plays in psychological wellbeing. Germer
and Neff (2019) also propose that self-compassion may be relevant in the context of self-
criticism and difficult emotions such as shame, as it is difficult to remain mindful when
meeting such intense emotions.
The MSC program focuses on experiential learning and inquiry-based teaching,
guiding participants through formal and informal practices, such as meditation, experiential
exercises and group discussion (Germer & Neff, 2019). The focus is teaching skills and
building emotional resources to use in daily life, and therefore the program is not considered
psychological therapy. The MSC program is typically structured as an eight-week program,
involving one two-hour session per week and one half-day retreat, with participants also
being asked to complete homework between sessions (Germer & Neff, 2019). However, the
program may also be delivered in an intensive format (Center for Mindful Self-Compassion,
2017). The intensive MSC program includes the same content as the eight-week program,
eight two-hour sessions and a half-day retreat, but is delivered over an intensive five-day
period. It is not clear when the intensive MSC program was introduced. However, the
intensive MSC program is listed as an offering on the Center for Mindful Self-Compassion
website (Center for Mindful Self-Compassion, 2017) and is delivered by the authors of the
program, Christopher Germer and Kirsten Neff, as well as other trained MSC facilitators.
Research Investigating the Mindful Self-Compassion Program
The first evaluation of the MSC program was a pilot study and randomized
controlled trial conducted by the authors of the program (Neff & Germer, 2013). Participants
were recruited from the general public, as the program was designed to be delivered to the
general population (Neff & Germer, 2013). Results of the pilot study showed participation in
the eight-week program significantly increased self-compassion, mindfulness, life-
satisfaction and happiness, and significantly decreased depression anxiety and stress (Neff &
Germer, 2013). Findings of the randomized controlled trial showed that compared to a wait-
list control, the intervention led to significant increases in self-compassion (large effect size),
mindfulness (medium effect size), compassion for others (medium effect size) and life
satisfaction (medium effect size) (Neff & Germer, 2013). Findings also showed that the
intervention led to significant decreases in depression (large effect size), anxiety (medium
effect size), stress (small effect size) and avoidance (medium effect size), compared to the
waitlist control (Neff & Germer, 2013). These initial findings highlight the promising
beneficial effects of the MSC program, and the need for a further investigation into the
effectiveness of the program.
To my knowledge, the MSC program has not yet been evaluated independently in a
meta-analysis or systematic review, and only one other randomized-controlled trial has
investigated the effects of the manualised eight-week MSC program. This study randomly
allocated participants with diabetes to participate in the MSC program or to a waitlist control
(Friis, Johnson, Cutfield, & Consedine, 2016). Findings showed participation in the program
led to significant increases in self-compassion and significant decreases in depression and

diabetes-specific distress, with changes maintained at three-month follow up (Friis et al.,
2016). Metabolic outcomes also improved following participation in the MSC program,
suggesting that the MSC program improves both mental and physical health outcomes in
people with diabetes (Friis et al., 2016). These findings provide additional support for the
promising beneficial effects of the MSC program.
Pilot studies have further investigated the effectiveness of the eight-week MSC
program among different populations. Delaney (2018) investigated the MSC program among
a sample of nurses from a range of disciplines. Findings showed significant increases in self-
compassion, mindfulness, compassion satisfaction and resilience, as well as significant
decreases in secondary traumatic stress and burnout following participation in the program
(Delaney, 2018). Effect sizes were large for all measures (Delaney, 2018). The MSC program
has also been investigated among a Chinese community sample (Finlay-Jones, Xie, Hung,
Ma, & Guo, 2018). Findings showed self-compassion and compassion for others significantly
increased, and distress, depression, anxiety, stress, rumination, maladaptive perfectionism
and fear of self-compassion all significantly decreased following participation in the program
(Finlay-Jones et al., 2018). Again, effect sizes were large for all measures (Finlay-Jones et
al., 2018). The MSC program has also been investigated in a sample of clinical and health
psychology students (Yela, Gómez-Martínez, Crego, & Jiménez, 2020). Yela et al. (2020)
used a quasi-experimental design, assigning participants to two groups based on their level of
adherence to the MSC program. Participants with high adherence showed greater
improvements in self-compassion, mindfulness and psychological wellbeing compared to
participants with low adherence (Yela et al., 2020). However, there were no significant
differences between groups for measures of depression and anxiety (Yela et al., 2020). Taken
together these findings suggest that the MSC program may be beneficial for improving
wellbeing among a range of different populations. However, it is important to note that the
findings from these pilot studies are limited due to the nature of the study and lack of control
groups.
On review of the literature, it becomes evident that the field of research investigating
the manualised MSC program is limited. However, researchers have investigated adaptions to
the MSC program which bear on the question of effectiveness of the MSC program.
Adaptions have involved modifications to the manualised MSC program or a selection of
self-compassion exercises that are included in the MSC program. The MSC program has
been adapted for adolescents in a program called Making Friends with Yourself (MYA;
Hobbs & Bluth, 2016). Research has shown the MYA program to improve self-compassion,
mindfulness, life-satisfaction, gratitude and curiosity, depression and perceived stress among
adolescents (Bluth & Eisenlohr-Moul, 2017; Bluth, Gaylord, Campo, Mullarkey, & Hobbs,
2016). The MYA program has also been delivered online via a video conferencing platform
to young adult cancer survivors (Campo et al., 2017; Lathren, Bluth, Campo, Tan, & Futch,
2018). Findings showed that the online MYA program led to improvements in self-
compassion, mindfulness, post-traumatic growth, anxiety, depression, social isolation and
body image (Campo et al., 2017; Lathren et al., 2018). Other interventions deviate further
from the manualised MSC program. For example, researchers have investigated three-week
interventions that involve practices that are included in the MSC program. Randomized
controlled trials have shown these brief self-compassion interventions to improve self-
compassion, mindfulness and other measures of psychological wellbeing, compared to active
and waitlist controls (Albertson, Neff, & Dill-Shackleford, 2015; Haukaas, Gjerde, Varting,
Hallan, & Solem, 2018; Smeets, Neff, Alberts, & Peters, 2014). Although these studies
utilised adaptions that deviate from the manualised MSC program, the findings provide
evidence for the effectiveness of self-compassion practices that are included in the MSC
program.
In summary, the field of literature examining the manualised MSC program, and the
adaptions and practices of the MSC program, is promising. The effect of the MSC program
has been investigated using a range of mental health outcomes among a range of different
populations. However, it is clear that the research examining the effectiveness of the MSC
program on wellbeing is in its infancy. There are a number of limitations and a number of
important areas for future research.
Limitations and Future Directions
The Mindful Self-Compassion Program and Shame
On review of the literature it becomes evident that there is an important gap in the
field of research on MSC: an investigation of the effect the MSC program has on shame. This
gap in the literature is particularly noteworthy, as part of the rationale for the MSC program
is that self-compassion is important when meeting difficult emotions like shame (Germer &
Neff, 2019). Shame is a self-conscious emotion that involves the negative evaluation of the
self as inferior, undesirable or worthless (Tangney & Dearing, 2002; Tangney, Stuewig, &
Mashek, 2007). Internal shame refers to an individual’s perception of themselves, and
external shame refers to an individual’s perception of how others evaluate them (Gilbert,
1998). Meta-analyses have shown internal and external shame are associated with depressive
and anxiety symptoms (Cândea & Szentágotai-Tătar, 2018a; Kim, Thibodeau, & Jorgensen,
2011). In both meta-analyses, external shame was shown to be more strongly associated with
symptoms of depression and anxiety than internal shame (Cândea & Szentágotai-Tătar,
2018a; Kim et al., 2011). These findings reiterate the importance of an effective intervention
to address internal and external shame, and the importance of this gap in the literature.
Self-compassion has been considered as the “ultimate antidote” to shame (Neff &
Germer, 2018, p. 123). Theoretically it is. The three components of self-compassion (self-
kindness, common humanity, mindfulness) counteract different aspects of shame (Johnson &
O’Brien, 2013). More specifically, self-kindness counters negative self-evaluation, common
humanity counters isolation, and mindfulness counters the preoccupation with distressing
mental activity and emotion (Germer & Neff, 2019). While this theoretical justification
exists, the research base examining the relationship between shame and self-compassion is
somewhat limited.
Studies have shown self-compassion is negatively associated with internal shame
(Barnard & Curry, 2012; Mosewich, Kowalski, Sabiston, Sedgwick, & Tracy, 2011; Woods
& Proeve, 2014; Zhang et al., 2018) and external shame (Ferreira, Pinto-Gouveia, & Duarte,
2013; Proeve, 2020). Researchers have also started to explore the effect self-compassion
interventions have on shame. Johnson and O’Brien (2013) investigated the effect of a self-
compassion writing exercise on internal shame in a randomized controlled trial. Participation
in the self-compassion exercise led to significant decreases in internal shame. Similarly,
Cândea and Szentágotai-Tătar (2018b) found a brief self-compassion training intervention
significantly reduced internal shame among socially anxious participants in a randomized
controlled trial. Gilbert and Proctor (2006) investigated the effects of Compassionate Mind
Training, an intervention for clinical populations with high shame and self-criticism. Findings
showed the Compassionate Mind Training intervention significantly reduced external shame
and increased participants feelings of warmth and their ability to be self-soothing (Gilbert &
Proctor, 2006). Taken together, these findings suggest that self-compassion may be important
for both internal and external shame. These findings also support the propositions that
targeting self-compassion in an intervention may be effective for reducing shame (Germer &
Neff, 2019; Woods & Proeve, 2014).
The MSC Program refers to shame as something it addresses. Part of the rationale for
the MSC Program is that self-compassion is relevant in the context of meeting intense and
difficult emotions such as shame (Germer & Neff, 2019). In addition, the MSC Program
includes the topic of shame and an optional ‘working with shame’ practice. While there is
evidence to support the proposition that self-compassion may be important in reducing
shame, research has yet to examine whether the MSC program is in fact beneficial for shame.
It is therefore important that future research investigates the effect of the MSC program on
shame, both internal and external shame.
The Mindful Self-Compassion Program Modalities
Upon review of the literature, it becomes apparent that there is a lack of consensus
regarding the term mindful self-compassion. Some studies use the term mindful self-
compassion to refer to self-compassion exercises or refer to a series of self-compassion
exercises as the MSC Program (e.g., Eriksson, Germundsjö, Åström, & Rönnlund, 2018;
Guo, Zhang, Mu, & Ye, 2020). Germer and Neff (2019) state in the MSC program manual,
that labelling a program MSC can only occur if the content includes 80% or more of the MSC
program. However, this does not seem to be the case. These discrepancies are likely to be
explained by the fact that the manual was published only in 2019. However, it is important to
consider this limitation.
It is interesting to note research to date has yet to investigate the effectiveness of the
intensive modality of the MSC program. The intensive program contains the same content as
the eight-week program but is delivered over an intensive five-day period. The intensive
MSC program is delivered to members of the general public due to its advantages, for
example time commitment. Given the findings showing the beneficial effects of brief self-
compassion interventions (Albertson et al., 2015; Haukaas et al., 2018; Smeets et al., 2014), it
is likely that the intensive MSC program would be beneficial for psychological wellbeing.
However, it is important that further research investigates the effect of delivering the MSC
program over an intensive five-day period, and whether the different modality influences the
beneficial outcomes of the MSC Program that have been documented to date.
When considering different modalities, it is also important to consider the advantages
of delivering the MSC program online or using different technologies. For example, using an
online video conferencing platform to deliver the MSC program to facilitate accessibility.
Adaptions of the MSC program have been delivered online via video conferencing platforms
(Campo et al., 2017; Lathren et al., 2018). Findings have shown that these online adaptions of
the MSC program lead to improvements in psychological wellbeing (Campo et al., 2017;
Lathren et al., 2018). Based on these findings it would be anticipated that delivering the MSC
program online via video conferencing platforms would be beneficial for improving
psychological wellbeing. However future research investigating the effects of delivering the
manualised MSC program online on measures of psychological wellbeing is warranted.
The Mindful Self-Compassion Program and Mindfulness-Based Programs
Considering the rationale for the MSC program and the research to date investigating
the MSC program, question is raised as to whether the MSC program would compare to
mindfulness-based programs in terms of the benefits for psychological wellbeing.
Compassion-based interventions have the potential to be largely beneficial for mental health
(Austin et al., 2020; Ferrari et al., 2019; Kirby, Tellegen, & Steindl, 2017) and it is interesting
to consider whether research into compassion-based interventions will follow the same
exponential trajectory as research into mindfulness-based programs. As Germer and Neff
(2019) state, it is an empirical question as to whether self-compassion should be taught
implicitly or explicitly, and to understand the common and unique benefits of compassion-
based interventions and mindfulness-based interventions. The two types of interventions may
complement one another or be more effective in different contexts; for example, compassion-
based interventions may be more relevant for high self-criticism (Germer & Neff, 2019). It
would make for a very interesting comparison and would answer the questions and debate
regarding the cultivation of self-compassion. Therefore, future research to compare the
effectiveness of the MSC program and MBIs is warranted.
Other Considerations for Future Research into the Mindful Self Compassion Program
As the evidence base for the MSC program grows, it will be interesting to investigate
the mechanisms by which the MSC program leads to improvements in psychological
wellbeing. While increases in self-compassion are expected to be important, question is
raised about the role of mindfulness in the beneficial effects of the MSC program on
psychological wellbeing. Previous research has highlighted that mindfulness is important for
the development of self-compassion (Evans et al., 2018; Sevel et al., 2020). The authors of
the MSC program also note the importance of mindfulness in self-compassion and in the
MSC program (Germer & Neff, 2019; Neff & Germer, 2013). Therefore, future research
should investigate the mechanisms by which the MSC program leads to improvements in
psychological wellbeing.
As the field of research is in its early stages, many studies investigating the MSC
program have used observational pilot study designs with small sample sizes. These pilot
studies are an important first step to determine the feasibility and acceptability of the program
(Kirby et al., 2017). However, large scale controlled studies will be required in future to
further examine the effectiveness of the MSC program for psychological wellbeing. These
studies include comparing the MSC program to waitlist and active controls, and to
established effective interventions.
Conclusion
The MSC program appears to be a feasible and acceptable intervention for enhancing
self-compassion, mindfulness and other measures of psychological wellbeing. However, on
review of the literature, it becomes evident that the field of research on the MSC program is
in its early stages. There are a number of areas for future research. Importantly, research to
date has yet to investigate the effect of the MSC program on shame, despite the fact that self-
compassion has been considered to be important in reducing shame and the rationale for the
MSC program. Research has also yet to investigate other modalities of the MSC program,
including the intensive MSC program, or using different technologies to deliver the MSC
program online. It is important that future research addresses these gaps in the literature,
before moving to large scale controlled studies to further examine the effectiveness of the
MSC program compared to waitlist and active controls, and well established interventions
including MBIs. Although further research is warranted, the MSC program appears to be a
promising intervention to enhance psychological wellbeing and mental health.

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018-9548-9
Running head: MINDFUL SELF-COMPASSION AND WELLBEING 24
Journal Article
Effects of the Mindful Self-Compassion Program on Shame and Psychological Wellbeing:
A Pilot Study
This article is intended for submission to the Journal of Clinical Psychology, which adheres
to the APA reference style. The article meets the Master of Clinical Psychology thesis
requirement of 5000-8000 words (including tables, figures, references).
Word Count: 7720

MINDFUL SELF-COMPASSION AND WELLBEING 25
Effects of the Mindful Self-Compassion Program
on Shame and Psychological Wellbeing: A Pilot Study
Mindful Self-Compassion and Wellbeing
Contact details for corresponding author:
Email address included here.
Address: The University of Adelaide, School of Psychology, North Terrace, Adelaide, South Australia,
AUSTRALIA 5005.
ORCID: To be included.
Acknowledgements: Dr Michael Proeve and Tina Gibson.
Data availability: Available from first author.
Funding: No funding was received.
Conflicts of interest: The author declares that there are no conflicts of interest.
Ethics approval: Approvals were provided by The University of Adelaide’s Human Research Ethics Sub-
Committee for the School of Psychology.
Consent: All participants provided informed consent by participation in the online survey.
Permission to reproduce material from other sources: Not applicable.
Clinical trial registration: Not registered.

Abstract
Objectives
The Mindful Self-Compassion (MSC) program is a manualised group program designed to
help individuals cultivate self-compassion. This study aimed to investigate the effectiveness
of eight-week and five-day modes of the MSC program on shame and measures of wellbeing.
Methods
Members of the general public completed online measures of self-compassion, mindfulness,
internal shame, external shame, depression, anxiety and stress, before and after participation
in the eight-week (N = 8; M age = 56.38; 75% female) or five-day MSC program (N = 7; M
age = 47.86; 86% female).
Results
Participants in the eight-week program showed significant increases in self-compassion and
mindfulness, and significant decreases in internal shame, depression, anxiety and stress, with
medium to large effect sizes. External shame decreased with a large effect, but findings were
not statistically significant. Participants in the five-day program showed significant increases
in self-compassion and mindfulness. Internal shame, external shame, depression, anxiety and
stress decreased but findings were not statistically significant. Effect sizes ranged from small
to large. Reliable change indices supported findings for eight-week and five-day programs.
Conclusion
This study supports previous research that the MSC program is beneficial for improving
wellbeing. The study also provides preliminary evidence that the MSC program may be
effective in reducing shame. Research using controlled study designs and more representative
samples is required to further evaluate the effectiveness of the program.
Keywords: Self-compassion; Mindfulness; Intervention; Shame; Psychological wellbeing.

Self-compassion is defined as a healthy attitude about the self and is conceptualised as
including three components: self-kindness, common humanity and mindfulness (Neff, 2003).
Self-kindness involves being kind, understanding and accepting of oneself in the midst of
suffering, instead of being self-critical; common humanity involves recognising and
acknowledging one’s experiences are part of being human, instead of feeling isolated; and
mindfulness involves being aware of one’s thoughts and feelings, holding them in balanced
awareness instead of becoming over identified with them (Germer & Neff, 2019; Neff, 2003).
The field of literature investigating self-compassion is expanding exponentially. Meta-
analyses show self-compassion is positively associated with psychological wellbeing (Zessin,
Dichkäuser, & Garbade, 2015), and negatively associated with symptoms of psychological
disorders with large effect sizes (MacBeth & Gumley, 2012). Based on these findings that
highlight the benefits of self-compassion for wellbeing, researchers have started to explore
interventions designed to enhance self-compassion. In particular, researchers have focused on
Mindfulness-Based Interventions (MBIs), moving towards the development of compassion-
based programs, including the Mindful Self-Compassion (MSC) program.
MBIs, including Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990)
and Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2013)
have been widely investigated, with findings showing their beneficial effects on mental
health outcomes (Hofmann, Sawyer, Witt, & Oh, 2010; Khoury, Sharma, Rush, & Fournier,
2015). MBIs implicitly foster self-compassion through the practices and messages that are
delivered. Studies have shown participation in MBIs leads to increases in self-compassion
(Evans, Wyka, Blaha, & Allen, 2018; Gu, Strauss, Bond, & Cavanagh, 2015; Proeve, Anton,
& Kenny, 2018; Sevel, Finn, Smith, Ryden, & McKernan, 2020). There is also emerging
evidence that suggests self-compassion plays an important role in the beneficial effects of
MBIs on mental health and wellbeing (Evans et al., 2018; Keng, Smoski, Robins, Ekblad, &
Brantley, 2012; Kuyken et al., 2010; Sevel et al., 2020). For example, Evans et al. (2018)
found a serial mediation effect when examining the relationship between MBSR,
mindfulness, self-compassion and mood. Participation in MBSR led to subsequent increases
in mindfulness, self-compassion and then improvements in mood (Evans et al., 2018). The
reverse model of MBSR leading to subsequent increases in self-compassion, mindfulness and
then improvements in mood, was not significant (Evans et al., 2018). Sevel et al. (2020)
replicated these findings when examining the relationship between MBSR and psychological
distress. That is, MBSR led to subsequent increases in mindfulness, self-compassion and then
improvements in psychological distress (Sevel et al., 2020). Again, the reverse model of
MBSR leading to subsequent increases in self-compassion, mindfulness, and then
improvements in psychological distress, was not significant (Sevel et al., 2020).
This emerging evidence that suggests self-compassion plays an important role in the
beneficial effects of MBIs, raises the question whether self-compassion should be taught
explicitly in an intervention. As Kazdin (2007) states, understanding the mechanisms of
psychological interventions allows clinicians to optimise therapeutic change. Therefore, if
self-compassion is taught implicitly in MBIs, and if self-compassion does play a role in the
beneficial effects of MBIs, therapeutic change may be optimized by explicitly teaching self-
compassion. In other words, an intervention that focuses specifically on the cultivation of
self-compassion may be important to maximise benefits for psychological wellbeing. This
argument provides the rationale for compassion-based interventions, including the MSC
program (Germer & Neff, 2019; Neff & Germer, 2013).
The MSC program is a manualised and structured group program developed by
Christopher Germer and Kirsten Neff (Germer & Neff, 2019; Neff & Germer, 2013). The
MSC program was designed specifically to enhance self-compassion among members of the
general public (Germer & Neff, 2019; Neff & Germer, 2013). The MSC program focuses on
experiential learning and inquiry-based teaching, guiding participants through formal and
informal practices, such as meditation, experiential exercises and group discussion (Germer
& Neff, 2019). The focus of the program is on teaching skills and building emotional
resources to use in daily life; therefore, the program is not considered psychological therapy.
The MSC program is typically structured as an eight-week program (Germer & Neff, 2019).
The eight-week program involves one two-hour session per week and one half-day retreat,
with participants also being asked to complete homework between sessions. However, the
MSC program is also delivered to members of the general public using an intensive structure
(Center for Mindful Self-Compassion, 2017). The intensive MSC program includes the same
content as the eight-week program, eight two-hour sessions and a half-day retreat, but it is
delivered over an intensive five-day period.
The evaluation of a new intervention initially involves pilot feasibility studies, and
then progresses to randomized controlled trials to compare the intervention to controls or
well-established effective treatments (Kirby, Tellegan, & Steindl, 2017). Neff and Germer
(2013) first investigated the MSC program in a pilot study and randomized controlled trial
among participants of the general public. Findings showed that participation in the MSC
program led to significant increases in self-compassion (large effect size), mindfulness
(medium effect size), compassion for others (medium effect size) and life satisfaction
(medium effect size), compared to a waitlist control (Neff & Germer, 2013). Participation in
the MSC program also led to significant decreases in depression (large effect size), anxiety
(medium effect size), stress (small effect size) and avoidance (medium effect size), compared
to a waitlist control (Neff & Germer, 2013). These initial findings highlight the promising
beneficial effects of the MSC program for psychological wellbeing, and the need for further
investigation into the effectiveness of the MSC program.

On review of the literature it becomes clear that the field of research investigating the
MSC program is in its early stages (Austin et al., 2020; Germer & Neff, 2019; Kirby et al.,
2017; Neff & Germer, 2013). To my knowledge, the MSC program has not been examined
independently in a meta-analysis or systematic review. In fact, to my knowledge, only one
other randomized-controlled trial has investigated the effectiveness of the MSC program. In
this study, participants with diabetes were randomly allocated to participate in the eight-week
MSC program or to a waitlist control (Friis, Johnson, Cutfield, & Consedine, 2016).
Participation in the program led to significant increases in self-compassion and improvements
in metabolic outcomes, and decreases in depression and diabetes-specific distress, compared
to a waitlist control (Friis et al., 2016). Effect sizes were large (Friis et al., 2016). Pilot
studies have examined the feasibility of the eight-week MSC program among participants
from different professions (Delaney, 2018; Yela, Gómez-Martínez, Crego, & Jiménez, 2020)
and different cultural backgrounds (Finlay-Jones, Xie, Huang, Ma, & Guo, 2018). In these
studies, participants showed significant improvements in measures of wellbeing following
participation in the eight-week MSC program, including self-compassion, mindfulness,
resilience, burnout, depression, anxiety and stress (Delaney, 2018; Finlay-Jones et al., 2018;
Yela et al., 2020). Effect sizes were large for these measures (Delaney, 2018; Finlay-Jones et
al., 2018). However, the findings need to be interpreted with caution due to the nature of the
studies. Nevertheless, taken together these findings support the promising beneficial effects
of the eight-week MSC program for psychological wellbeing,
Research has yet to investigate the effectiveness of the intensive five-day MSC
program. Although the intensive five-day MSC program covers the same content as the eight-
week MSC program, it is interesting to consider whether the intensive modality would
influence the beneficial outcomes of the MSC program that have been documented in the
literature to date. Researchers have investigated brief self-compassion interventions that

deviate from the MSC program. For example, researchers have investigated the effect of
various three-week self-compassion interventions that include practices of the MSC program
(Albertson, Neff, & Dill-Shackleford, 2015; Haukaas, Gjerde, Varting, Hallan, & Solem,
2018; Smeets, Neff, Alberts, & Peters, 2014). Randomized controlled trials show these brief
interventions improve self-compassion, mindfulness and other measures of wellbeing,
compared to waitlist and active control groups (Albertson et al., 2015; Haukaas et al., 2018;
Smeets et al., 2014). Based on these findings, it is likely that the five-day intensive MSC
program would be effective in improving measures psychological wellbeing. However,
further research is warranted.
While evidence suggests the MSC program is beneficial for improving multiple
measures of wellbeing, research has yet to investigate the effect of the MSC program on
shame. This gap in the literature is particularly noteworthy, as part of the rationale for the
MSC program is that self-compassion is important when meeting intense emotions such as
shame (Germer & Neff, 2019). Shame is a self-conscious emotion that involves the negative
evaluation of the self as inferior, undesirable or worthless (Tangney & Dearing, 2002;
Tangney, Stuewig, & Mashek, 2007). Internal shame refers to an individual’s perception of
themselves, and external shame refers to an individual’s perception of how others evaluate
them (Gilbert, 1998). Meta-analyses show internal and external shame are associated with
depressive symptoms and anxiety symptoms (Cândea & Szentágotai-Tătar, 2018a; Kim,
Thibodeau, & Jorgensen, 2011). Therefore, an intervention that addresses both internal and
external shame is important.
Neff and Germer (2018) state “self-compassion is the ultimate antidote to shame” (p.
123). Theoretically it is. The three components of self-compassion (self-kindness, common
humanity, mindfulness) counteract aspects of shame (Johnson & O’Brien, 2015). More
specifically, self-kindness counters negative self-evaluation, common humanity counters

isolation, and mindfulness counters the preoccupation with distressing mental activity and
emotion (Germer & Neff, 2019). While this theoretical justification exists, the research base
examining the relationship between self-compassion and shame is somewhat limited.
Previous research has investigated the relationship between self-compassion and
shame. Studies show self-compassion is negatively associated with internal shame and
external shame in a diverse set of populations (Barnard & Curry, 2012; Ferreria, Pinto-
Gouveia, & Duarte, 2013; Mosewich, Kowalski, Sabiston, Sedgwick, & Tracy, 2011; Woods
& Proeve, 2014; Zhang et al., 2018). Researchers have also investigated the effect of self-
compassion practices on internal and external shame. For example, Cândea and Szentágotai-
Tătar (2018b) found that a brief two-week self-compassion intervention led to significant
decreases in internal shame compared to a waitlist control. Johnson and O’Brien (2013)
similarly found a brief self-compassion writing exercise led to significantly lower internal
shame compared to a waitlist control. Gilbert and Proctor (2006) investigated the effects of
Compassionate Mind Training on external shame. Participants showed significant decreases
in external shame following the Compassionate Mind Training intervention (Gilbert &
Proctor, 2006). Taken together, these findings suggest that self-compassion practices may
influence both internal shame and external shame. These findings also support the
proposition that targeting self-compassion in an intervention may be effective for reducing
shame (Germer & Neff, 2019; Woods & Proeve, 2014). Based on the theory and research to
date, it is expected that the MSC program, both eight-week and five-day modes, would be
effective in reducing internal shame and external shame. However further research is
warranted.
The Present Study: Aims and Hypotheses
The present study had two primary aims. First, the study aimed to investigate the
effect of participation in the eight-week and five-day modes of the MSC program on shame.
As shame has been shown to play an important role in psychopathology, these findings may
highlight important clinical implications regarding the MSC program as an intervention. The
study also aimed to examine the effect of the intensive MSC program on other measures of
psychological wellbeing. This intensive modality of the MSC program may have practical
advantages for members of the general public, thus increasing accessibility and engagement.
Due to COVID-19, the eight-week MSC program was unable to be delivered in its
typical face-to-face group program format. Therefore, the eight-week program was delivered
online via a video conferencing platform. As COVID-19 restrictions had lifted prior to the
start of the five-day MSC program, the five-day program was delivered using the typical
face-to-face group program format. The unforeseen circumstances and discrepancies in the
delivery of both eight-week and five-day modes of the MSC program, meant that it was not
appropriate to compare the two interventions in this study.
The study used a repeated measures design to investigate the effectiveness of eight-
week and five-day modes of the MSC program on measures of internal and external shame,
and other measures of psychological wellbeing including self-compassion, mindfulness,
depression, anxiety and stress. Participants were asked to complete the quantitative measures
before, one-week after and two-months after their participation in the eight-week or five-day
MSC program.
For both eight-week and five-day modes of the MSC program, it was hypothesised
that internal shame and external shame would decrease from pre-intervention to post-
intervention. It was also hypothesised that for both eight-week and five-day modes of the
MSC program, participants would show increases in self-compassion and mindfulness, and
decreases in depression, anxiety and stress, from pre-intervention to post-intervention.

Methods
Participants
Eight-week MSC program. Eleven members of the general public enrolled in an
eight-week MSC program at a South Australian mindfulness clinic completed pre-
intervention measures. Participants ranged in age from 32 to 86 years (M = 54.09; SD =
15.51). Nine participants were female (81.8%) and two participants were male (18.2%). All
participants identified as being of Caucasian cultural background (100%). In terms of highest
level of formal education, seven participants (63.6%) reported completion of a university
degree, three participants (27.3%) reported completion of a TAFE, trade or technical
qualification, and one participant (9.1%) reported graduation from high school. All
participants reported having previous meditation experience (100%). Eight participants
completed post-intervention measures and three participants completed follow-up measures.
Five-day MSC program. Eight members of the general public enrolled in a five-day
MSC program at a South Australian mindfulness clinic completed pre-intervention measures.
Participants ranged in age from 30 to 61 years (M = 48.38; SD = 9.68). Seven participants
were female (87.5%) and one participant was male (12.5%). All participants identified as
Caucasian (100%) and indicated that their highest level of formal education completed was a
university degree (100%). All participants reported having previous meditation experience
(100%). Seven participants completed post-intervention measures and two participants
completed follow-up measures.
Measures
Self-compassion. Self-compassion was measured using the Self-Compassion Scale
(SCS; Neff, 2003). The SCS consists of 26-items that assess three dimensions of self-
compassion with six subscales; self-kindness versus self-judgement, mindfulness versus
overidentification, and common humanity versus isolation (Neff, 2003). Participants are
asked to respond to items using a 5-point Likert scale ranging from 1 (almost never) to 5
(almost always). Negative items of the self-judgement, isolation, and over-identification
subscales are reversed scored before calculating a total self-compassion score. Only total self-
compassion scores were used in this study, with higher scores reflecting greater self-
compassion. The SCS is a valid measure of self-compassion and shows high internal
consistency for the subscales (α = .75 to α = .81) and for total self-compassion (α = .92; Neff,
2003). In the present study, Cronbach’s Alpha for the SCS total score was .91.
Mindfulness. Participants completed the 15-item Five Facet Mindfulness
Questionnaire (FFMQ-15; Baer, Carmody, & Hunsinger, 2012) as a measure of mindfulness.
The 15-item FFMQ was developed as a short form of the original FFMQ (Baer, Smith,
Hopkins, Krietemeyer, & Tomey, 2006), and has been shown to be a valid and reliable
alternative (Gu et al., 2016). Items assess five facets of mindfulness, including observing,
describing, acting with awareness, non-judging, and non-reactivity. Participants are asked to
indicate how true responses are of them using a 5-point Likert scale from 1 (never or very
rarely true) to 5 (very often or always true). A total FFMQ-15 score is calculated by
summing all items. Only total FFMQ-15 scores were used in this study, with higher scores
indicating greater mindfulness. The FFMQ-15 scale shows good internal consistency (α = .80
to α = .85; Baer et al., 2012). The FFMQ-15 Cronbach’s Alpha for the present study was .76.
Internal shame. Internal shame was measured using the Experience of Shame Scale
(ESS; Andrews, Qian, & Valentine, 2002). The ESS contains 25-items assessing areas of
characterological, behavioural and bodily shame. Participants are asked about their
experiences, cognitions and behaviours for each area of shame, using a 4-point Likert scale
from 1 (not at all) to 4 (very much) to indicate their response. A total ESS score is calculated
by summing all 25 items. Only total scores were used in the present study, with higher total
ESS scores reflecting greater internal shame. The ESS demonstrates construct validity and
high internal consistency (α = .92; Andrews et al., 2002). Cronbach’s Alpha for the ESS in
the present study was .97.
External shame. External shame was measured using the Other as Shamer Scale
(OAS; Goss, Gilbert & Allan, 1994). The OAS assesses how the self is evaluated by others
by asking participants to respond to a list of statements regarding their feelings and
experiences. The OAS contains 18-items using a 5-point Likert scale from 0 (never) to 4
(always). The total OAS score is calculated by summing all 18 items. Higher OAS scores
indicate greater external shame. The OAS demonstrates construct validity and high internal
consistency (α = .92; Goss et al., 1994; Balsamo et al., 2015). In the present study,
Cronbach’s Alpha for the OAS was .96.
Depression, anxiety and stress. Participants completed the Depression, Anxiety and
Stress Scale 21 (DASS-21) as a short form of the original Depression, Anxiety and Stress
Scale (DASS; Lovibond & Lovibond, 1995). For each item participants are asked to indicate
how often they have experienced symptoms of anxiety, depression and stress using a 4-point
scale from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time).
The depression, anxiety and stress subscale scores are calculating by summing relevant
subscale items, and a total score is obtained by summing all items. The DASS-21 score is
doubled to conform to original DASS-42 norms. Subscale scores for depression, anxiety and
stress were used in the present study, with higher scores indicating greater psychological
distress. The DASS-21 demonstrates construct validity and good internal consistency for the
depression (α = .88), anxiety (α = .82) and stress (α = .90) subscales, and for the total scale (α
= .93; Henry & Crawford, 2005). In the present study, Cronbach’s Alpha was .90 for the
depression subscale, .84 for the anxiety subscale, .85 for the stress subscale, and .94 for total
DASS-21.
Demographic items. Participants were asked to answer a series of demographic
questions, including their age, gender, cultural background and highest level of formal
education completed. Participants were also asked to report on their previous meditation
experience with reference to the type of meditation and duration of practice.
Procedure
The study was approved by the School of Psychology Human Research Ethics Sub-
Committee at the University of Adelaide. Members of the general public enrolled in an eight-
week MSC program and a five-day MSC program at a South Australian mindfulness clinic,
were invited to participate in the research study. Eligibility criteria was for participants to be
over 18 years of age and fluent in English. The facilitator of the MSC program provided
participants with an information sheet about the research study and informed consent was
obtained prior to participation in the research study. Participants who expressed interest in the
research study were sent an email invitation containing a link to an online questionnaire and a
unique identifier to enable matching of responses. Participants were asked to complete the
online pre-intervention questionnaire before starting the MSC program. The pre-intervention
questionnaire contained demographic questions and quantitative measures of self-
compassion, mindfulness, internal shame, external shame, depression, anxiety and stress.
One-week after completing the MSC program, participants were sent another email invitation
containing the link to the online post-intervention questionnaire including the same
quantitative measures of self-compassion, mindfulness, internal shame, external shame,
depression, anxiety and stress. Two-months after completing the MSC program, participants
were sent a final email invitation to complete the online follow-up questionnaire containing
the same quantitative measures of self-compassion, mindfulness, internal shame, external
shame, depression, anxiety and stress.

Intervention
Eight-week MSC program. The eight-week MSC program followed the manualised
MSC program developed by Christopher Germer and Kirsten Neff (Germer & Neff, 2019;
Neff & Germer, 2013). The program involved eight weekly two-hour sessions and a half-day
retreat. The program was independently facilitated by a certified MSC Teacher Trainer and
Mentor, and a trained MSC Teacher. Due to the impact of COVID-19, the eight-week MSC
program was delivered via an online video conferencing platform. The program retained the
same structure, content, practices and exercises as the manualised eight-week MSC program.
Five-day MSC program. The five-day intensive MSC program followed the same
content as the eight-week MSC program, eight two-hour sessions and a half day retreat,
delivered over consecutive days. The program was independently facilitated by the same
certified MSC Teacher Trainer and Mentor, and trained MSC Teacher. As COVID-19
restrictions had lifted, the five-day intensive MSC program was delivered using the face-to-
face group program format.
Results
Data were analysed using the software package IBM SPSS Statistics 26. Preliminary
analyses were conducted to test normality, the presence of outliers and missing data. Tests of
normality based on the Kolmogorov-Smirnov statistic indicated that scores on all measures
were normally distributed for the eight-week program sample. There were two outliers in the
data, one for post-intervention mindfulness scores and one for post-intervention depression
scores. Inspection of SPSS boxplots revealed that these outliers were not extreme points. The
outliers were not considered large enough to substantially influence the results, and therefore
the outliers were not excluded from the data. For the five-day program sample, tests of
normality based on the Kolmogorov-Smirnov statistic indicated scores on all measures were
normally distributed, except pre-intervention depression scores, post-intervention external

shame scores and post-intervention stress scores. There were no outliers in the data.
Inspection of histograms, plots, skewness and kurtosis, indicated minor deviations from
normality that were not considered enough to make analyses untenable. Therefore, no
transformations of data were performed.
For the eight-week program, post-intervention data was provided by eight participants
(72.7%) and follow-up data was provided by three participants (27.3%). The loss of data may
be explained by one participant withdrawing from the eight-week program, and other
participants choosing not to complete the post-intervention and follow-up questionnaires. For
the five-day program, post-intervention data was provided by seven participants (87.5%) and
follow-up data was provided by two participants (25%). As all participants completed the
five-day program, the loss of data may be explained by participants choosing not to complete
the post-intervention and follow-up questionnaires. This loss of data limited the sample
available for pre-post analyses, and restricted follow-up analyses.
Data for the eight-week and five-day programs were analysed separately due to the
different modalities of the programs. As the eight-week program was delivered online and the
five-day program was delivered face-to-face, it was not appropriate to combine or compare
data for the two programs. The results for the eight-week and five-day program are therefore
reported separately.
To answer the research question and test hypotheses, data for the eight-week program
and five-day programs were analysed at three levels. Firstly, a series of paired-samples t-tests
were conducted to investigate whether there were statistically significant differences between
pre-intervention and post-intervention measures. Effect sizes were then examined using
Cohen’s d effect sizes for repeated measures (Dunlap, Cortina, Vaslow, & Burke, 1996).
Finally, Reliable Change Indices (RCIs) were calculated to examine change at an individual
level (Evans, Margison, & Barkham, 1996). RCIs were calculated for pre-intervention to
post-intervention scores, and for pre-intervention to follow-up scores. Considering these three
levels of analysis together to answer the research questions and test hypotheses and was
deemed important given the small sample size available for analyses and the nature of the
study.
Descriptive Analyses
Prior to examining intervention outcomes for the eight-week and five-day programs,
participants who completed post-intervention measures (n = 15) were compared with
participants who completed pre-intervention measures but dropped out of the research study
(n = 4). Independent samples t-tests revealed that there was a significant difference between
the two groups for self-compassion and mindfulness. Those who dropped out of the study
showed higher self-compassion (M = 86.75, SD = 14.84) than those who completed post-
intervention measures (M = 63.07, SD = 13.09), t (17) = -3.14, p = .006. Those who dropped
out of the study also showed higher mindfulness (M = 51.50, SD = 6.76) than those who
completed post-intervention measures (M = 41.87, SD = 5.94), t (17) = -2.81, p = .012.
Independent samples t-tests revealed no significant differences between those who completed
post-intervention measures and those who dropped out of the study on measures of internal
shame, t (17) = 1.56, p = .137, external shame, t (17) = 0.71, p = .490, depression, t (17) =
1.38, p = .185, anxiety, t (17) = 0.47, p = .648, and stress, t (17) = 0.92, p = .372.
Prior to examining intervention outcomes for the eight-week and five-day programs,
participants enrolled in each program were compared on demographic and baseline measures.
Independent samples t-tests revealed no significant differences between participants in the
eight-week program and five-day program at baseline for age, t (17) = 0.92, p = .372, self-
compassion, t (17) = 0.04, p = .969, mindfulness, t (17) = 0.20, p = .844, internal shame, t
(17) = 0.45, p = .656, external shame, t (17) = 0.67, p = .511, depression, t (17) = 1.52, p =
.148, anxiety, t (16) = 0.16, p = .877 , and stress, t (17) = 0.94, p = .362.
Intervention Outcomes
Eight-week MSC program. Paired samples t-tests were conducted to evaluate pre-
post changes in measures of self-compassion, mindfulness, internal shame, external shame,
and depression, anxiety and stress, for the eight participants who completed post-intervention
measures. As displayed in Table 1, results showed statistically significant increases in self-
compassion and mindfulness, and statistically significant decreases in internal shame,
depression, anxiety and stress. Effect sizes were large for all measures, except for anxiety and
stress which had medium effect sizes. External shame decreased with a large effect size, but
findings were not statistically significant.
Table 1
Eight-week MSC program pre-intervention and post-intervention means, standard deviations,
t-tests, and effect sizes for all measures.
Pre-intervention Post-intervention Intervention change

Measure n=8 n=8
ta d
M (SD) M (SD)
Self-compassion 60.50 (15.04) 81.88 (11.98) -6.37** 0.79
Mindfulness 40.63 (4.53) 49.00 (4.04) -3.55* 1.30
Internal shame 71.13 (19.45) 58.50 (9.97) 2.93* 0.84
External shame 31.75 (17.76) 24.50 (7.98) 1.75 0.80
Depression 23.00 (7.93) 12.00 (8.49) 2.99* 1.65
Anxiety 12.25 (8.17) 5.25 (4.40) 3.01* 0.69
Stress 19.00 (7.63) 13.25 (6.58) 2.42* 0.78
Note. M = mean; SD = standard deviation; t = t-test; d = Cohen’s d effect size.

adf = 7.
* p < .05, ** p < .01 (two-tailed).

Reliable change indices. RCIs were calculated to examine change scores for all
measures at an individual level (Evans et al., 1998). The RCI value was calculated using
descriptive data from the present study and published reliability coefficients for measures
(Andrews et al., 2002; Baer et al., 2012; Balsamo et al., 2015; Goss et al., 1994; Henry &
Crawford, 2005; Neff, 2003). RCIs were calculated for pre-intervention to post-intervention
scores, and for pre-intervention to follow-up scores. RCIs are presented in Appendix A.
Pre-intervention to post-intervention. Eight participants provided data for pre-post
analyses. Results indicated that eight participants showed reliable increases in self-
compassion (100%) and that six participants showed reliable increases in mindfulness (75%).
Results showed reliable decreases in internal shame for four participants (50%), external
shame for two participants (25%), depression for six participants (75%), anxiety for three
participants (37.5%) and stress for three participants (37.5%).
Pre-intervention to follow-up. Three participants completed follow-up measures. Of
the three participants, one participant showed a reliable increase in self-compassion (33.3%)
and two participants showed reliable increases in mindfulness (66.7%). One participant
showed a reliable decrease in internal shame (33.3%) and no participants showed reliable
decreases in external shame (0%). All participants showed reliable decreases in depression
(100%), no participants showed reliable decreases in anxiety (0%) and one participant
showed a reliable decrease in stress (33.3%).
Changes in RCI. Comparing the RCI analyses from pre-intervention to post-
intervention and from pre-intervention to follow-up, shows that most participants’ reliable
changes were maintained at two-month follow up. However, some differences were observed
in the RCIs at pre-intervention to post-intervention and pre-intervention to follow-up. Two
participants who showed reliable changes in self-compassion at post-intervention, did not
show reliable changes at follow-up. One participant who did not show a reliable change in
depression at post-intervention, showed a reliable change at follow up. This suggests the
participant’s score for depression decreased between post-intervention and follow-up.
Another participant who did not show a reliable change in stress at post-intervention, showed
a reliable change at follow-up. Again, this finding suggests the participant’s stress score
decreased between post-intervention and follow-up.
Five-day MSC program. Paired samples t-tests were conducted to evaluate pre-post
changes in measures of self-compassion, mindfulness, internal shame, external shame, and
depression, anxiety and stress, for the seven participants who completed post-intervention
measures. As shown in Table 2, there were statistically significant increases in self-
compassion and mindfulness, with large effect sizes. Internal shame, external shame,
depression, anxiety and stress decreased but findings were not statistically significant. While
these findings were not significant, it is important to note the large effect size for internal
shame, and the medium effect sizes for external shame and stress. Effect sizes for depression
and anxiety were small.

Table 2
Five-day MSC program pre-intervention and post-intervention means, standard deviations, t-
tests, and effect sizes for all measures.

Measure n=7 n=7
ta d
M (SD) M (SD)
Self-compassion 66.00 (10.82) 83.29 (15.74) -3.23* 2.06
Mindfulness 43.29 (7.34) 53.00 (9.81) -2.61* 1.58
Internal shame 64.71 (21.85) 54.43 (19.20) 2.12 1.13
External shame 25.57 (20.65) 20.57 (21.69) 1.50 0.52
Depression 12.86 (14.14) 12.29 (15.21) 0.38 0.15
Anxiety 13.66 (13.70) 12.33 (11.96) 1.09 0.09
Stress 15.71 (9.05) 15.43 (13.55) 0.10 0.55

a
df = 7.
* p < .05, ** p < .01 (two-tailed).
Reliable change indices. RCIs were again calculated to investigate individual level
change for all measures (Evans et al., 1998). The RCI value was calculated using descriptive
data from the present study and published reliability coefficients for measures (Andrews et
al., 2002; Baer et al., 2012; Balsamo et al., 2015; Goss et al., 1994; Henry & Crawford, 2005;
Neff, 2003). RCIs were calculated for pre-intervention to post-intervention scores, and for
pre-intervention to follow-up scores. RCIs are presented in Appendix B.
Pre-intervention to post-intervention. Seven participants provided data for pre-post
analyses. Results indicated that five participants showed reliable increases in self-compassion
(71.4%) and that four participants showed reliable increases in mindfulness (57.1%). Results
showed reliable decreases in internal shame for two participants (28.6%), external shame for
one participant (14.3%), and stress for two participants (28.6%). No participants showed
reliable decreases in depression (0%) and anxiety (0%).
Pre-intervention to follow-up. Two participants completed follow-up measures. Both
participants showed reliable increases in self-compassion (100%) and mindfulness (100%).
One participant showed a reliable decrease in internal shame (50%) and external shame
(50%). No participants showed reliable decreases in depression (0%) or anxiety (0%), but
both participants showed reliable decreases in stress (100%).
Changes in RCI. Comparing the RCI analyses from pre-intervention to post-
intervention and from pre-intervention to follow-up, shows that most participants’ reliable
changes were maintained at two-month follow up. However, some differences were
observed. One participant showed a reliable change in self-compassion at follow-up that was
not observed in the pre-post analyses, suggesting self-compassion increased between post-
intervention and follow-up. One participant also showed a reliable change in mindfulness at
follow-up, that was not observed in the pre-post analyses. This also suggests that mindfulness
increased between post-intervention and follow-up. Similarly, one participant also showed a
reliable change in stress at follow-up that was not observed in the pre-post analyses. Again,
this suggests stress decreased from post-intervention to follow-up.
Discussion
Overview of Findings
The present study aimed to investigate the effectiveness of eight-week and five-day
modes of the MSC program on internal and external shame, and other measures of wellbeing
including self-compassion, mindfulness, depression, anxiety and stress. To answer the
research question and to test the hypotheses, three levels of analysis were considered:
statistical significance, effect size and reliable change. Considering these three levels of
analysis was important given the small sample size and the nature of the study. For both
eight-week and five-day modes of the MSC program, it was hypothesised that participants
would show increases in self-compassion and mindfulness, and decreases in internal shame,
external shame, depression, anxiety and stress from pre-intervention to post-intervention.
Eight-week MSC program. For the eight-week program, participants showed
significant increases in self-compassion and mindfulness with large effect sizes. RCIs
supported these findings, with all participants showing reliable increases in self-compassion,
and three quarters of participants showing reliable increases in mindfulness following their
participation in the program. These findings support the hypothesis. Participants showed
significant decreases in internal shame with a large effect size, with RCIs indicating half of
the participants showed reliable decreases in internal shame. These findings support the
hypothesis. External shame decreased, but findings were not statistically significant. It is
important to note that there was a large effect size for external shame, and RCIs indicated that
a quarter of participants showed reliable changes in external shame. Therefore, while the
hypothesis was not supported, the eight-week program does still seem to have an effect on
external shame. Finally, participants showed significant decreases in depression with a large
effect size, anxiety with a medium effect size, and stress with a medium effect size. RCIs
supported these findings, with three quarters of participants showing reliable decreases in
depression, and approximately one third of participants showing reliable decreases in anxiety
and stress. Therefore, the hypothesis was supported.
Five-day MSC program. For the five-day program, participants showed significant
increases in self-compassion and mindfulness with large effect sizes. RCIs supported these
findings, with over half of participants showing reliable increases in self-compassion and
mindfulness. These findings support the hypothesis. Internal shame decreased with a large
effect size however findings were not statistically significant. RCIs indicated that
approximately one third of participants showed reliable decreases in internal shame.
Similarly, external shame decreased with a medium effect size, but findings were not
statistically significant. RCIs indicated one participant showed a reliable change in external
shame. While these findings do not support the hypothesis, it appears that the five-day
program may have some effect on internal shame and external shame to a lesser extent.
Participants did not show significant decreases in depression or anxiety. Effect sizes were
small and RCIs indicated no participants showed reliable decreases in depression or anxiety.
Therefore, the hypothesis was not supported. Finally, participants did not show a significant
decrease in stress. There was a medium effect size and RCIs indicated that about one third of
participants showed reliable decreases in stress. These findings do not support the hypothesis
but suggest that the five-day program may have some effect on stress.
The Mindful Self-Compassion Program and Shame
A primary aim of this study was to investigate the effect of the eight-week and five-
day modes of the MSC program on internal shame. For the eight-week program, the findings
showing significant improvements in internal shame with a large effect size, suggest that the
eight-week MSC program is effective in improving internal shame. For the five-day program,
the decreases in internal shame were not statistically significant, however the large effect size
suggests that the intensive program may also have an effect on internal shame. To my
knowledge, this is the first study to investigate the effect of the manualised MSC program on
internal shame. Previous studies have shown self-compassion is associated with internal
shame (Barnard & Curry, 2012; Mosewich et al., 2011; Woods & Proeve, 2014; Zhang et al.,
2018), and that brief self-compassion interventions reduce internal shame (Cândea &
Szentágotai-Tătar, 2018b; Johnson & O’Brien, 2013). The present study findings that the
eight-week MSC program may be effective in improving internal shame are therefore in line
with previous research. The present study findings that the five-day intensive MSC program
may not be effective in improving internal shame are surprising, as previous research has
shown brief self-compassion interventions are effective in improving internal shame.
However, the tests of statistical significance were dependent on small participant numbers.
The large effect size suggests that the five-day program may have an effect on external
shame. It is interesting that for both eight-week and five-day modes of the MSC program,
effect sizes for internal shame were large. This suggests that overall, MSC may be helpful for
internal shame. However, further research to support these findings is warranted.
Another primary aim of the study was to examine the effect of the eight-week and
five-day modes of the MSC program on external shame. For the eight-week program, the
findings showed external shame decreased with a large effect size, but the results were not
statistically significant. Similarly, for the five-day program, the findings showed external
shame decreased with a medium effect size, but the results were not statistically significant.
Again, to my knowledge, this is the first study to investigate the effect of the manualised
MSC program on external shame. Self-compassion has been shown to be negatively
associated with external shame (Ferreira et al., 2013; Proeve, 2020), and self-compassion
interventions have been shown to reduce external shame (Gilbert & Proctor, 2006).
Therefore, the findings that suggest the eight-week and five-day MSC programs may not be
effective in improving external shame are unexpected. However, again it is important to note
that this is based on statistical significance, which was dependent on small participant
numbers. Although findings were not statistically significant, the large and medium effect
size for the eight-week and five-day program respectively, suggest that the MSC program
may have some effect on external shame. However, future research to investigate the effect
of the MSC program on external shame is warranted.
Taken together, the present study contributes to the field of literature by providing
preliminary evidence that the MSC program may be effective in reducing shame. It appears
that the MSC program has an effect on internal shame, more so, but also external shame to a
reasonable extent. Internal shame refers to an individual’s perception of themselves as
inferior, undesirable or worthless; whereas external shame refers to an individual’s
perception of how others evaluate them, for example others perceiving them as inferior,
undesirable or worthless (Gilbert, 1998; Tangney & Dearing, 2002; Tangney et al., 2007). It
is perhaps not surprising that the MSC program may have a greater effect on internal shame,
as the focus of the program is on the self. However, this proposition warrants further
research. As internal and external shame are associated with psychological wellbeing
(Cândea & Szentágotai-Tătar, 2018b; Kim et al., 2011), an intervention that addresses both
internal and external shame is important. Therefore, the effect of the MSC program on shame
should be further investigated, using large scale controlled study designs.
The Intensive Mindful Self-Compassion Program and Measures of Wellbeing
The study also aimed to examine the effect of the five-day intensive MSC program on
other measures of psychological wellbeing including self-compassion, mindfulness,
depression, anxiety and stress. Participants in the five-day intensive MSC program showed
significant increases in self-compassion and mindfulness with large effect sizes. These
findings suggest that the five-day intensive MSC program may be effective in enhancing self-
compassion and mindfulness. Participants in the intensive MSC program did not show
significant decreases in depression, anxiety and stress, and effect sizes were small to medium.
These findings suggest that the five-day intensive MSC program may not be effective in
improving depression, anxiety and stress.
Research has yet to investigate the effectiveness of the five-day intensive MSC
program on measures of psychological wellbeing. However, previous studies have shown
brief self-compassion interventions to have beneficial effects on measures of psychological
wellbeing including self-compassion, mindfulness, depression and anxiety (Albertson et al.,

2015; Haukaas et al., 2018; Smeets et al., 2014). Findings that the intensive MSC program
may be effective in improving self-compassion and mindfulness, are in line with this
previous research. However, the findings that the intensive MSC program may not be
effective in improving depression, anxiety and stress are surprising. It is important to note
that the MSC program is considered a skills and resource building program, not
psychological therapy. Therefore, the intensive MSC program appears to be doing what it is
intended to do.
The findings for the five-day program are interesting given the present study findings
and previous research that shows the eight-week MSC program is effective in improving
depression, anxiety and stress (Neff & Germer, 2013). There are a number of factors that may
explain why the intensive MSC program did not have an impact on measures of depression,
anxiety and stress. It may be that the MSC program requires a longer duration to affect
depression, anxiety and stress symptoms. For example, the longer duration of the eight-week
program, compared to the five-day program, may provide participants with more of an
opportunity to integrate and practice exercises. It is important that further research is
conducted using large scale controlled studies to further investigate the effectiveness of the
five-day MSC program. This future research is important, as the intensive modality of the
MSC program is currently being delivered to the general public, and the intensive modality
may have practical advantages of increasing engagement and accessibility.
The Online Mindful Self-Compassion Program and Measures of Wellbeing
While not initially intended, the present study also addressed another gap in the field
of research on the MSC program; the effect of delivering the manualised MSC program
online via a video conferencing platform on measures of psychological wellbeing. The
findings of the present study suggest that this online eight-week MSC program was effective
in improving self-compassion, mindfulness, depression, anxiety and stress. Researchers have

used online video conferencing platforms to deliver adaptions of the MSC program, with
findings showing the beneficial effects of these adaptions on psychological wellbeing
(Campo et al., 2017; Lathren, Bluth, Campo, Tan, & Futch, 2018). However, research has not
yet investigated the delivery of the manualised eight-week MSC program using these
technologies. The present study findings therefore contribute to the field of literature by
providing preliminary evidence that the online delivery of the MSC program may be effective
for improving wellbeing.
These findings for the online eight-week MSC program are in line with previous
research that documents the beneficial effects of the traditional face-to-face eight-week MSC
program on measures of psychological wellbeing (Delaney, 2018; Finlay-Jones et al., 2018;
Friis et al., 2016; Neff & Germer, 2013; Yela et al., 2020). This suggests that the online
delivery of the MSC program may be comparable to the traditional face-to-face delivery of
the MSC program. However, future research to compare the two modalities is warranted.
While future research is needed, the present study findings provide promise for the online
delivery of the manualised MSC program using videoconferencing platforms. This online
modality may hold advantages for members of the general public in terms of accessibility and
engagement. These considerations are particularly relevant at this current point in time, given
the circumstances and restrictions of COVID-19. Therefore, future research to support these
findings is important.
Limitations and Future Research
This pilot study had a number of limitations that should be considered. Firstly, the
study lacked a control group. Therefore, it cannot be concluded that the findings were due to
participation in the MSC program. It may be that other variables influenced the results. It is
important to note that the data was collected during COVID-19. In addition, the samples for
the eight-week and five-day intensive MSC programs were small. For both programs, several
participants did not complete post-intervention measures, and most participants did not
complete follow-up measures. This attrition limited the sample available for pre-post
analyses, and restricted follow-up analyses. That is, it was not appropriate to conduct
statistical analyses with the small sample size at follow-up, which restricted the conclusions
that could be drawn. In addition, the findings of the present study and the size of the effects
highlight that the small sample size may have may have impacted on statistical significance.
Furthermore, most participants were females who were highly educated with previous
meditation experience. This sample limits the generalisability of the findings to the wider
population.
Based on these limitations and the findings of the present study, there are a number of
areas for future research. First, future research should further investigate the effectiveness of
the MSC program on internal and external shame. These findings may provide important
clinical implications regarding the effectiveness of the MSC program as an intervention for
both internal and external shame. Future research should also further examine the intensive
MSC program, and compare the effectiveness of the five-day MSC program to the eight-
week MSC program. While the intensive modality may hold advantages for individuals
regarding time commitment, it is important that participants benefit from the intensive
duration of the program. It is also important to further investigate the effectiveness of the
online delivery of the MSC program. Again, the online MSC program should be compared to
the original face-to-face MSC program to ensure the beneficial effects of the MSC program
are maintained. Finally, it is important that this future research utilises large scale controlled
studies to further investigate the effectiveness of the MSC program. For example, comparing
the MSC program with waitlist or active control groups, or to other well-established effective
interventions.
Conclusion
Despite the limitations of this pilot study, the findings support previous research that
the MSC program is beneficial for improving measures of psychological wellbeing, including
self-compassion, mindfulness, depression, anxiety and stress. The present study also provides
preliminary evidence that the MSC program may be effective in reducing shame. These
findings are important given that shame has been shown to play an important role in
psychopathology. The study findings suggest that the intensive program may not be effective
in improving some measures of psychological wellbeing, however further research is
required. Finally, the present study findings provide preliminary evidence that the online
delivery of the MSC program is effective in improving psychological wellbeing. These
findings are also important, as online technologies may increase accessibility and
engagement with the MSC program. This is particularly relevant today given the current
circumstances of COVID-19. It is important that future research utilises controlled study
designs and more representative samples to further evaluate the effectiveness of the program.
Although further research is required, the MSC program appears to be a promising
intervention for enhancing psychological wellbeing and mental health.

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Appendix A
Table 1
Reliable change indices for the eight week MSC program.
Self-compassion Mindfulness Internal shame External shame Depression Anxiety Stress

ID
Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2
1 +16* - +11* - -18* - -22* - -24* - -14* - -6 -
2 +15* - +4 - -19* - -7 - -8* - -18* - -16* -
3 +21* - +12* - -24* - -23* - -14* - -10* - -6 -
4 +19* - +5* - -3 - -7 - -10* - -2 - -14* -
5 +44* +42* +14* +11* -24* -20* -13 -6 -24* -23* -4 -7 +2 -6
6 +15* -2 -5 +4 12 +1 +5 -1 -14* -20* -6 -8 0 -14*
7 +21* +8 +11* +12* -10 -12 +9 -2 +2 -23* 0 -1 +4 -2
8 +20* - +15* - -15 - 0 - +4 - -2 - -6* -
Notes. ID = Participant ID; Change1 = Change in scores from pre-intervention to post-intervention; Change2 = Change in scores from pre-
intervention to follow-up. Reliable Change Index (RCI) values: Self-compassion = 11.79; Mindfulness = 4.87; Internal shame = 15.25; External
shame = 13.92; Depression = 7.61; Anxiety = 9.61, Stress = 6.69.
*Reliable change
Appendix B
Table 2
Reliable change indices for the five-day MSC program.
Self-compassion Mindfulness Internal shame External shame Depression Anxiety Stress

ID
Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2 Change1 Change2
1 +25* - +20* - -9 - -10 - +2 - -4 - -8* -
2 +7 +35* +3 +14* -5 -7 +4 0 +4 -3 0 0 +6 -9*
3 -2 - -4 - 5 - +1 - 0 - -4 - +2 -
4 +12* - +4 - -8 - +2 - +2 - +2 - +10 -
5 +27* - +9* - 0 - -1 - 0 - +2 - +2 -
6 +40* - +24* - -24* - -11 - -6 - - - -4 -
7 +12* +30* +12* +14* -31* -34* -20* -17* -6 -6 -4 -6 -10* -9*
Notes. ID = Participant ID; Change1 = Change in scores from pre-intervention to post-intervention; Change2 = Change in scores from pre-
intervention to follow-up. Reliable Change Index (RCI) values: Self-compassion = 11.79; Mindfulness = 4.87; Internal shame = 15.25; External
shame = 13.92; Depression = 7.61; Anxiety = 9.61, Stress = 6.69.
*Reliable change.
Tables
Table 1
Eight-week MSC program pre-intervention and post-intervention means, standard deviations,
t-tests, and effect sizes for all measures.

Measure n=8 n=8
ta d
M (SD) M (SD)
Self-compassion 60.50 (15.04) 81.88 (11.98) -6.37** 0.79
Mindfulness 40.63 (4.53) 49.00 (4.04) -3.55* 1.30
Internal shame 71.13 (19.45) 58.50 (9.97) 2.93* 0.84
External shame 31.75 (17.76) 24.50 (7.98) 1.75 0.80
Depression 23.00 (7.93) 12.00 (8.49) 2.99* 1.65
Anxiety 12.25 (8.17) 5.25 (4.40) 3.01* 0.69
Stress 19.00 (7.63) 13.25 (6.58) 2.42* 0.78

adf = 7.
* p < .05, ** p < .01 (two-tailed).

Table 2
Five-day MSC program pre-intervention and post-intervention means, standard deviations, t-
tests, and effect sizes for all measures.

Measure n=7 n=7
ta d
M (SD) M (SD)
Self-compassion 66.00 (10.82) 83.29 (15.74) -3.23* 2.06
Mindfulness 43.29 (7.34) 53.00 (9.81) -2.61* 1.58
Internal shame 64.71 (21.85) 54.43 (19.20) 2.12 1.13
External shame 25.57 (20.65) 20.57 (21.69) 1.50 0.52
Depression 12.86 (14.14) 12.29 (15.21) 0.38 0.15
Anxiety 13.66 (13.70) 12.33 (11.96) 1.09 0.09
Stress 15.71 (9.05) 15.43 (13.55) 0.10 0.55

a
df = 7.
* p < .05, ** p < .01 (two-tailed).

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Running head: RESEARCH PROJECT i

Effects of the Mindful Self-Compassion Program

on Shame and Psychological Wellbeing: A Pilot Study

This report is submitted in partial fulfillment of the degree of

Limitations and Future Research ..................................................................................... 51

support, enthusiasm and encouragement.

The University of Adelaide

Word Count: 4022

This literature review aimed to provide an overview of the Mindful Self-Compassion

appears to be a feasible and acceptable intervention for enhancing self-compassion,

the MSC program, which are discussed.

Mindfulness-based interventions (MBIs) have been widely investigated, with findings

toward the self and is conceptualised as including three components: self-kindness,

of self-compassion in the beneficial effects of MBIs, suggests that specifically focusing on

the cultivation of self-compassion may be beneficial to optimize therapeutic change. This

rationale led to the development of the Mindful Self-Compassion (MSC) program, a

manualised intervention designed specifically to help individuals cultivate self-compassion.

directions for research on the MSC program.

Rationale of the Mindful Self-Compassion Program

Mindfulness and Mindfulness Based Programs

Mindfulness is defined as focusing on the present moment without judgement (Kabat-

Zinn, 2003). MBIs, including Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn,

analysis conducted by Hofmann et al. (2010) investigated the effect of mindfulness-based

clinical conditions. Findings showed that mindfulness-based therapy was effective in

2010). Mindfulness-based therapy was also shown to be moderately effective in improving

al., 2010). Another meta-analysis investigated the effects of mindfulness-based therapy,

in clinical and nonclinical populations.

A systematic review using meta-analytic techniques revealed consistent evidence for

cognitive and emotional reactivity, mindfulness, rumination, and worry, as mechanisms

suggested preliminary evidence for self-compassion as a mechanism underlying the effects of

studies investigated the role of self-compassion in addition to mindfulness in the effects of

et al., 2012; Kuyken et al., 2010).

mediation effect, whereby participation in mindfulness-based therapy led to increases in

mindfulness, which subsequently led to increases in self-compassion, and then improvements

in mood. The reverse model of mindfulness-based therapy leading to increases in self-

indirectly through mindfulness. Again, the reverse model of mindfulness-based therapy

leading to increases in self-compassion, then mindfulness, and then improvements in

mindfulness is important for the development of self-compassion, and that self-compassion

health. However further research is needed to support these findings.

Self-Compassion and Cultivating Self-Compassion

Self-compassion is defined as a healthy attitude about the self and is conceptualised as

suffering, instead of being self-critical; common humanity involves recognising and

that the literature on self-compassion is expanding exponentially. Meta-analyses show self-

wellbeing across multiple domains, including psychopathology, psychological health,

emotional intelligence, self-concept, body image, motivation and interpersonal functioning

(Neff et al., 2018).

Based on the beneficial associations of self-compassion with wellbeing and

the beneficial effects of MBIs, specifically focusing on the cultivation of self-compassion

Self-compassion is taught implicitly in MBIs, with research showing participation in MBIs

“nothing ever needed to be said explicitly” about self-compassion (Kabat-Zinn, 2005, p.

understanding the mechanisms of psychological interventions allows clinicians to optimise

therapeutic change. Therefore, if self-compassion does play a role in the effectiveness of

mindfulness-based programs, therapeutic change may be optimized by explicitly using and

teaching self-compassion practices.

The Mindful Self-Compassion Program

The Mindful Self-Compassion (MSC) program is a manualised and structured group

role of mindfulness in self-compassion, describing the MSC program as a hybrid between

meeting such intense emotions.

The MSC program focuses on experiential learning and inquiry-based teaching,