My changed body: breast cancer, body image, distress and self-compassion

Negative alteration to a woman’s body image is a common consequence of breast cancer diagnosis, associated medical intervention and treatment side-effects. Despite the inevitable occurrence of adverse side-effects and the distress it causes for some women, body image difficulties for a subset of breast cancer survivors are not always adequately addressed. Self-compassion is a novel psychological approach that has been used in non-oncology contexts to assist with distress and body image disturbance. However, such an approach has not been applied to difficulties experienced by breast cancer survivors, and hence constitutes a gap in the psycho-oncology research literature. The overall aim of this thesis was to explore the utilization of a self-compassion-based intervention to address body image disturbance in this population, using a series of four studies. An initial cross-sectional exploratory study (Study I) investigated the relevance of self-compassionate approaches to body image and its possible relationship to psychological distress. It was found that self-compassion was a significant factor in the relationship between body image disturbance and subsequent psychological distress in breast cancer survivors, with evidence of self-compassion acting as a mediator of this relationship. A proof-of-concept pilot study (Study II) was then undertaken to investigate the acceptability and feasibility of a self-compassion focused writing activity to assist with body image difficulties in breast cancer survivors, the “My Changed Body” intervention. It was demonstrated that self-compassionate writing produced immediate reduction in negative affect and enhancement in self-compassionate outlook, compared with individuals in the expressive writing only control group. Given the promising outcomes from this research, a third study (Study III) was undertaken to investigate the potential acceptability of an online version of the My Changed Body self-compassion based writing intervention amongst breast cancer consumers and breast cancer-related health professionals. This development study indicated moderate to high acceptability for an online self-compassion based writing intervention. The final study (Study IV) investigated, in a randomised controlled trial, the effectiveness of the online self-compassion writing intervention on negative affect and self-compassion. A total of 206 breast cancer survivors were randomized to receive either the self-compassion online intervention or an active control condition (i.e., unstructured expressive writing). It was found that women assigned to the structured self-compassion writing intervention exhibited significant less negative affect, particularly for younger women. Moreover, older women receiving the My Changed Body intervention had a significant enhancement of self-compassion. In sum, the findings from this thesis have important implications for researchers, health professionals and breast cancer survivors. This research has been the first to investigate and apply self-compassion as a possible intervention for adverse body image changes in breast cancer, hence addressing a current knowledge gap. The research findings have been translated to create and evaluate a user-friendly, accessible online intervention that is simple for health professionals to administer. Finally, and most importantly, female breast cancer survivors have been provided with a novel, evidence-based, effective approach that can, depending on their age, decrease negative affect related to adverse bodily changes and improve their levels of self-compassion.