A two-armed pragmatic randomized controlled trial comparing the effectiveness of two self-compassion interventions at reducing perceived stress

Introduction: A lack of self-compassion has been found to be associated with stress and a variety of psychological disorders. Interventions aimed at fostering self-compassion have been proposed as a promising approach to promoting public mental health. In the context of universal prevention, low-threshold interventions are needed. Against the background of substantial heterogeneity in effectiveness of self-compassion interventions at enhancing mental-health outcomes, the newly-developed guided digital intervention “Namah” and a pre-existing, broadly-available printed workbook as a bibliotherapeutic approach were investigated. Methods: In a randomized-controlled-trial (N = 200), we compared Namah and the above-mentioned workbook, both aiming to reduce stress by strengthening self-compassion in a universal prevention setting. Within- and between-group differences in perceived stress, the primary outcome, and further secondary outcomes were investigated eight weeks and six months after randomization via intention-to-treat analysis (ITT). Reporting follows CONSORT-guidelines. The study was registered in the German Clinical Trial Register (https://drks.de/search/en/trial/DRKS00027552), the approved primary registry of the (WHO) for Germany. Results: Exploratory analysis for both self-compassion interventions revealed significant and meaningful reductions in stress (d = 0.68–0.79), symptoms of depression (d = 0.30–0.48) and self-criticism (d = 0.40–0.55), as well as increased self-compassion (d = 0.54–0.63) within each group. However, during between-group analyses, ITT ANCOVA revealed no significant differences either at eight weeks post-intervention (d = 0.13) or at 6-month follow up (d = 0.14) for perceived stress or any secondary outcome. Various sensitivity analyses corroborated these findings. Discussion: Two distinct low-threshold approaches to fostering self-compassion seem beneficial for reducing stress and symptoms of depression. Although superiority of the guided digital intervention was expected, results suggested that both the digital and printed bibliotherapeutic formats are valuable candidates for mental health promotion in the general population, given the interventions are clearly structured, behaviorally oriented and provide at least a minimal regular human contact. Clinical Trial Registration: https://drks.de/search/en/trial/DRKS00027552, identifier DRKS00027552.