The Effects of a Self-compassion Therapist-led Online Group Treatment for Adolescents With Distress, Anxiety and Depression

Adolescence is a vulnerable period of growth and challenges, characterized by rapid physiological and emotional changes. All these changes happen at the same time as relationships expand. A developing self together with a pressure to "fit in" can lead to self-critic and distress. Without appropriate coping skills to manage these challenges, adolescents are more vulnerable to psychological problems. Distress, anxiety, and depression have also increased in the western world during the last years, and especially girls or young women are affected [1]. In addition, depressive disorders are the single largest contributor to global disability [2]. Adolescents-appropriate training in compassion may help adolescents successfully overcome the challenges in the future and help adolescents to take care of themselves.

Schools are not just about acquiring knowledge, they are playing a central role in cultivating necessary social, emotional, and ethical skills required to lead successful lives [3]. Recently, there has been a great interest in bringing mindfulness and compassion to educators and students.

The construct of compassion is defined by Paul Gilbert as a "sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it" [4] and include compassion for oneself, compassion for others, and receiving compassion from others. Compassion strategies are core competencies in life, already taught by large religions as Christianity and Buddhism, but now in a modern version along with new neurobiological research and cognitive behavior therapy interventions. These skills or strategies can be taught, but have not yet been widely used in the contexts of adolescents [3].

Research supporting compassion focused therapy for depression Compassion focused therapy (CFT) was developed two decades ago and is a well-established talking therapy for depression and stress [5]. Compassion has a protective effect against depression and suicidality [6], in youth. Training in compassion is linked to well-being and perceived life satisfaction [7]. Meta-analytic findings of CFT on adults has recently showed moderate effects on stress, depression and anxiety [7]. Studies with adolescents are few. For example one small study [8] with 34 14-17 year old students found that a mindful self-compassion school program in six weeks was feasible and acceptable. The intervention group had significantly greater self-compassion and less depression than the waitlist control.

The CFT intervention Compassion Focused Training (CFT). The investigators have developed a new manual for CFT training with seven modules [9] including 1) what is compassion, 2) understanding myself, 3) life-compass, 4) self-compassion and my body, 5) feelings and compassion, 6) create balanced thoughts, and 7) imagination. CFT is an internet-delivered (zoom or teams) real time group training (for 15-20 years old adolescents), 1,5h, in seven weeks. The youth will receive a manual for practice. The investigators were inspired by Professor Paul Gilbert, Mary Welford, and Elaine Beaumont's approach [10], but the investigators have shortened and adapted Welford and Beaumont manual to Swedish context. In addition, the investigators are influenced by cognitive behavior principles. Functional analyses and thoughts records are for example, used. The intervention focuses on the present and not on processing memories. The intervention is made for primary care and school health. A psychotherapist/psychologist or social worker will lead the training.