Zeniou, Elena; (2024) Compassionate Practices & Minority Stress:  Exploring Identity-Based Compassion for Gender and Sexuality Minoritised Identities. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

SYSTEMATIC REVIEW: Background: Gender Diverse (GD) populations face physical and mental health inequalities. The present review focuses on the role and impact of compassion in GD health and wellbeing by bringing together the available literature to date. The review aims to provide an understanding of how compassion features for GD people and to consider implications for research and intervention development. Method: Twenty studies met review inclusion criteria and formed part of the final analysis. Thematic synthesis was utilised to analyse data. ‘Qualitising’ processes were used for data assimilation due to the heterogeneity of studies, measurement tools, and outcomes. Results: The global theme of ‘Identity-based Compassion’ indicates that GD people experience the presence and absence of compassion both internally and relationally. The global theme is supported by two themes and five sub-themes. Discussion: Compassion from others and self-compassion appear integral to GD mental and physical health. The absence of compassion appears relevant to adverse health outcomes. Self-compassion can be developed through GD-specific therapeutic interventions. ‘Relational Compassion’ is observed as a form of identity-based compassion, indicating promise in the process of self-compassion development. Further research is needed to understand the role and potential of ‘Relational Compassion’ for minority stress health. EMPIRICAL PAPER: Background: Minoritised Sexual Identity (MSI) populations continue to face minority-stress and mental health inequalities. The utilisation of virtual reality (VR) with compassion-focused practices previously provided evidence of promising mental health outcomes for a non-MSI sample. This study utilised an MSI compassion-based VR intervention to identify components likely relevant to therapeutic change. Method: Seventeen MSI participants took part in a single-session compassion-based VR intervention. Semi-structured change process interviews were carried out. Data was analysed using Reflexive Thematic Analysis. Results: Three themes and nine sub-themes were identified. The focus on sexual identity journeys and associated affect appeared as an essential intervention component. Identity-based compassion benefitted from scaffolded support during the intervention. An identity-based script facilitated the enactment and receipt of compassion in the virtual reality environment. Conceptual and visual avatar features influenced connection to the intervention. Conclusions: Embodied compassionate practices in a VR relational simulation can facilitate the felt sense of compassion. The felt sense has potential implications for overcoming compassion barriers. The relational simulation could be harnessed across therapeutic modalities, to externalise and engage compassionately with difficulties. Technological and conceptual considerations for avatar personalisation could improve change processes. Further research is warranted to consider intersectional minority stress and modality integration.

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