Self-compassionate writing for breast cancer survivors

Aims of project To assess whether affect and mindset can be modified in the short term through a self-compassionate writing activity focused on body image. Plan and method Part One There are two parts to this research. The first part of the research involves completion of an online questionnaire package to collect background data. This should take about 20 minutes and is conducted in the convenience of the participant’s home. From this point participants will be randomised by the researcher into two groups (control and experimental) using the www.randomizer.org program. Part Two The second part involves a writing exercise and completion of a paper-based questionnaire which will be sent via mail. All participants will complete a brief pre-writing questionnaire (envelope 1) After this participants will open another envelope (envelope 2) with a set of instructions and writing paper. Participants in the control condition will receive instructions for unstructured descriptive writing regarding body image after treatment. They will be asked to write for a total of 4 pages with general writing guidelines (ie use of introduction, body, conclusion) but will receive no additional prompts or structure to their writing. Participants in the experimental condition will also engage in writing however using additional prompts designed to encourage a compassionate orientation to the self, modelled after the procedures of Leary et al (2007). Participants will be asked to write a response to each self-compassion prompt, comprising a total of 4 pages. These prompts are designed to elicit attitudes of self-kindness, mindfulness and feelings of common humanity and are based on the definition of self-compassion provided by Neff (2003). Immediately after completion of writing participants will be asked complete a post writing questionnaire that rates their affect using Likert scales as per Leary et al (2007). Participants will also complete an additional rating scale created to measure self-compassionate mindset. This entire package will be sent via post and a reply paid envelope will be provided for the return of pre & post writing questionnaires. Participants will be given the option of keeping their writing exercise or sending it in with their questionnaire responses. This will be entirely according to the participants preference. This part should take approximately 45 minutes in total and is undertaken in the convenience of the participant’s home. Measures: The Body Image Scale (BIS) was developed by Hopwood, Fletcher, Lee & Ghazal (2001) for use with oncology populations. It consists of 10 items to measure body image distress, including aspects of affect, behaviour and cognition. This scale shows high reliability (Cronbach’s alpha 0.93) and good clinical validity and sensitivity to change. The BIS has been widely cited by researchers in the oncology field (eg. Harcourt et al, 2003, Garry et al, 2004) The Self Compassion Scale (SCS) measures compassion towards the self, as rated by the participant. Twenty-six Likert scale items include a series of six sub-scales to assess self compassion using a total score. The SCS has been assessed to have good test-retest reliability (a=0.93) and validity, (Neff, 2003). The Depression, Anxiety and Stress Scale (DASS 21) is a short version of the full 42 item DASS scale developed by Lovibond & Lovibond (1995). The DASS 21 comprises 21 items (with three subscales, 7 items each) to measure respondent’s levels of depression, anxiety and stress. This instrument has been found to have satisfactory validity and reliability, and have higher user acceptability, (Henry and Crawford, 2005). The Body Image Appreciation Scale (BAS) was developed to assess body image. Higher scores indicate higher body appreciation. This scale has acceptable psychometric properties with item consistency of .94 for the scale and demonstrated construct validity (Avalos, Tylka & Wood-Baraclow, 2005). It is expected that the at home writing exercise and questionnaire completion will take no more than 45 minutes of participant time in total. Data collection and storage: Data collected will be stored in a password protected folder. Participant emails and data obtained will be stored separately and emails will not be linked to data. Only the study investigator and supervisors will have access to research data. All patient information obtained for the study will be de-identified before publication and dissemination of results.