The Effectiveness of Compassion Therapy on Cognitive Fusion and Self-Criticism in Older Adults with Post-Traumatic Stress Disorder

With an aging population, an increase in the provision of services to individuals experiencing Post Traumatic Stress Disorder (PTSD) is expected in care services for older adults. Therefore, this study was conducted with the aim of determining the effectiveness of compassion therapy on cognitive fusion and self-criticism in older adults with PTSD in Tabriz, Iran. The research method was quasi-experimental with a pretest-posttest design with a control group. The statistical population of the research included all older adults with PTSD living in Tabriz in 2022. The sample of the study included 30 older adults (65 to 75 years old) selected through convenience sampling method and according to the inclusion and exclusion criteria of the study, and were randomly assigned into experimental and control groups. The experimental group underwent Gilbert’s compassion therapy package in eight 90-minute weekly sessions. The questionnaires used in this research consisted of Thompson and Zuroff’s levels of self-criticism scale and Gillanders et al.’s cognitive fusion questionnaire. Data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS-22 software. The results revealed that in the post-test stage, there is a significant difference between the control and experimental groups in terms of cognitive fusion and self-criticism (P<.001). Based on the findings of this study, compassion therapy results in the decrease of cognitive fusion and self-criticism in older adults and can represent new horizons in clinical interventions and can be used as an effective intervention method to improve the mental health and quality of life in older adults.
EXTENDED ABSTRACT
 Introduction
Old age is one of the stages of human life evolution, and the population of older adults is increasing worldwide, with significant psychological attention being given to them. One of the disorders during this period appears to be post-traumatic stress disorder (PTSD). Studies have shown a significant association between self-criticism and PTSD among men and women who have experienced one or more traumatic events. Another variable associated with PTSD seems to be cognitive fusion. Various therapeutic methods have been employed to improve the psychological components of PTSD symptoms. One of the third-wave therapeutic approaches that seems to be effective in improving PTSD symptoms is compassion therapy. Reducing negative emotions and improving interpersonal relationships, compassion therapy can improve PTSD symptoms. Given the importance of the old age period and the position of older adults in society, the necessity of this research for psychologists and counselors to reduce cognitive fusion and self-criticism in older adults holds special significance. As there has been less focus on the effectiveness of compassion therapy on cognitive fusion and self-criticism in older adults in the research background, this study aimed to investigate the effectiveness of compassion therapy on cognitive fusion and self-criticism in individuals with PTSD.
Method
This was an experiment study with pretest-posttest design with a control group. The statistical population included all older adults aged 65 to 75 suffering from PTSD in Tabriz, Iran, in 2022, among whom 30 individuals meeting inclusion criteria of the study were selected through convenience sampling among people referred to Fajr Psychiatric Hospital in Tabriz. They were then randomly assigned in equal proportions to either the experimental or control group. The inclusion criteria consisted of (1) scoring higher than the mean on the cognitive fusion and self-criticism questionnaires, (2) age over 65 years, (3) having at least a primary school education, and (4) willingness to participate in the study. Exclusion criteria included (1) withdrawal from cooperation, (2) refusal to complete questionnaires, and (3) acute cognitive disorders. After the pretest was conducted and participants were asked to complete Thompson and Zuroff’s levels of self-criticism scale and Gillanders et al.’s cognitive fusion questionnaire, 30 eligible older adults willing to participate were selected through convenience sampling and randomly assigned to either the experimental or control group, with 15 individuals in each group. The experimental group underwent eight 90-minute weekly sessions of compassion therapy, conducted by the researcher, over an eight-week period at a psychological services center, while the control group received no intervention. Following the intervention sessions, the participants completed the above-mentioned questionnaires in post-test phase. Ethical considerations included obtaining written consent for participation in the study and ensuring the confidentiality of personal information. Finally, the data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS-21 software.
 Results
According to statistical method of the current study, Levene’s test of homogeneity of variances was initially employed to examine the homogeneity of variances between the two groups in the post-test phase. Levene’s test did not yield statistically significant results for cognitive fusion and self-criticism; hence, the assumption of homogeneity of variances was confirmed. Furthermore, the critical assumption of
ANCOVA, namely the homogeneity of regression coefficients, was investigated by examining the interaction effect of the independent variable and the pre-test of each dependent variable on its post-test. The results indicated non-significant F-values for cognitive fusion and self-criticism variables. Additionally, to assess the normal distribution assumption of the dependent variables, the Shapiro-Wilk test was utilized. According to the results of this test, normal distribution was observed in the variables as the obtained Z-value was not statistically significant. As shown in Table 1, there is a significant difference between the experimental and control groups in terms of cognitive fusion and self-criticism. In other words, compassion therapy led to a significant reduction in cognitive fusion and self-criticism in the experimental group.
Conclusion
The results indicated that compassion therapy can reduce cognitive fusion and self-criticism in older adults suffering from PTSD. In explaining these findings, it can be said that through compassion therapy, individuals learn to change their relationship with their thoughts and other internal experiences, viewing them as passing mental events. Accepting thoughts as they are, emotions as they are, and not more or less, leads to a weakening of cognitive fusion. Additionally, compassion therapy empowers older adults to question the flawed cycle of self-criticism and high self-expectations, and with a new and compassionate perspective towards themselves, redesign realistic and achievable standards and expectations that are not burdensome. Therefore, compassion therapy can be used as a low-cost, accessible, and practical educational or therapeutic program to improve self-criticism and cognitive fusion in older adults.
Ethical Consideration
Ethical Code
This article has an ethics code (IR.IAU.D.REC.1402.046) from the Ethics Committee of Islamic Azad University, Dezful Branch.
Financial Support
 This study had no financial support
Authors’ Contributions
Z.S: Conceptualization, methodology, software, validation, formal analysis Data curation; H.H: Resources, writing- original draft, writing-review & editing, Project administration, Supervision, Visioalization
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors express their gratitude to all study participants.
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