Role of Psychological Flexibility and Self-compassion in People on Home Parenteral Nutrition: Psychological, Line Care Adherence and Infection Outcomes

Sara Anne Rea, Victoria Marianne Samuel, Nuno Ferreira, Marc Owen Williams


Background: Home parenteral nutrition (HPN) is an often life-saving nutritional treatment. However, it requires meticulous adherence to line care procedures and poses challenges to daily activities which can impact a person’s quality of life (QOL) and psychological wellbeing. Less is understood about psychological processes that affect outcomes in HPN. Psychological flexibility (PF) and self-compassion (SC) have been identified as important processes in other chronic illness populations. This study aimed to examine the unique role of PF and SC in predicting psychological distress, wellbeing, QOL, line care adherence and line infections in adults on HPN.

Methods: The study was a cross-sectional, observational questionnaire design with data collected online through convenience sampling. Data collection was completed between May 2021 and February 2022; the study was advertised on online platforms and shared by relevant third sector organisations. Participants were adults currently on HPN. A measure of line care adherence was developed for the current study and the results of a principal components analysis indicated a final 9-item line care routine questionnaire.

Results: The sixty-six participants were primarily from the United Kingdom. Higher PF and SC were significantly correlated with the following outcomes in the predicted directions: lower psychological distress, higher wellbeing, higher QOL and increased line care adherence. Multiple linear regression models explained a significant proportion of the variance in all outcomes, except for line infections. PF was uniquely associated with lower total distress, lower anxiety, better wellbeing and higher QOL after controlling for SC, gender and age. Whereas SC was uniquely associated with lower total distress, depression and stress when controlling for PF, gender and age.

Conclusions: Interventions aimed at improving PF and SC may be beneficial to support the emotional wellbeing and QOL in individuals on HPN. Further research would benefit from prospective designs and consideration of objective measures of infection.


Home parenteral nutrition (HPN); Psychological flexibility (PF); Self-compassion (SC); Quality of life (QOL); Adherence.

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Ablett, J., Vasant, D. H., Taylor, M., Cawley, C., & Lal, S. (2018). Poor social support and unemployment are associated with negative affect in home parenteral nutrition–dependent patients with chronic intestinal failure. Journal of Parenteral and Enteral Nutrition, 43(4), 534-539.

Allan, P. J., Pironi, L., Joly, F., Lal, S., Van Gossum, A., Nutrition, H. A., & ESPEN, C. I. F. s. i. g. o. (2020). An international survey of clinicians’ experience caring for patients receiving home parenteral nutrition for chronic intestinal failure during the covid‐19 pandemic. Journal of Parenteral and Enteral Nutrition, 45(1), 43-49.

Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological medicine, 43(5), 897-910.

Baxter, J. P., Fayers, P. M., & McKinlay, A. W. (2005). A review of the instruments used to assess the quality of life of adult patients with chronic intestinal failure receiving parenteral nutrition at home. British journal of nutrition, 94(5), 633-638.

Baxter, J. P., Fayers, P. M., & McKinlay, A. W. (2008). The development and translation of a treatment-specific quality of life questionnaire for adult patients on home parenteral nutrition. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, 3(1), e22-e28.

Baxter, J. P., Fayers, P. M., & McKinlay, A. W. (2010). The clinical and psychometric validation of a questionnaire to assess the quality of life of adult patients treated with long‐term parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 34(2), 131-142.

Bayliss, K. (2018). Confirmatory Factor Analysis and further validation of the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT) [Unpublished doctoral dissertation] University of Nottingham].

Bermejo-Franco, A., Sánchez-Sánchez, J. L., Gaviña-Barroso, M. I., Atienza-Carbonell, B., Balanzá-Martínez, V., & Clemente-Suárez, V. J. (2022). Gender Differences in Psychological Stress Factors of Physical Therapy Degree Students in the COVID-19 Pandemic: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 19(2), 810.

Blüthner, E., Bednarsch, J., Stockmann, M., Karber, M., Pevny, S., Maasberg, S., … & Pratschke, J. (2019). Determinants of quality of life in patients with intestinal failure receiving long‐term parenteral nutrition using the SF‐36 questionnaire: a German single‐center prospective observational study. Journal of Parenteral and Enteral Nutrition, 44(2), 291-300.

Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior therapy, 42(4), 676-688.

Buetti, N., Marschall, J., Drees, M., Fakih, M. G., Hadaway, L., Maragakis, L. L., … & Rupp, M. E. (2022). Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 1-17.

Carvalho, S. A., Skvarc, D., Barbosa, R., Tavares, T., Santos, D., & Trindade, I. A. (2022). A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion‐focused therapy for chronic illness. Clinical psychology & psychotherapy, 29(2), 524-541.

Cederholm, T., Barazzoni, R., Austin, P., Ballmer, P., Biolo, G., Bischoff, S. C., … & Holst, M. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition, 36(1), 49-64.

Chambers, A., Hennessy, E., & Powell-Tuck, J. (2005). Longitudinal trends in quality of life after starting home parenteral nutrition: a randomised controlled study of telemedicine. Clinical Nutrition, 25(3), 505-514.

Chen, C., Zhu, D., Zhao, Z., & Ye, X. (2022). Quality of life assessment instruments in adult patients receiving home parenteral and enteral nutrition: A scoping review. Nutrition in Clinical Practice.

Cloutier, A., Deutsch, L., Miller, B., Leahy, G., Ablett, J., Healey, A., … & Taylor, M. (2021). Factors affecting antidepressant use by patients requiring home parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 46(1), 153-159.

Culine, S., Chambrier, C., Tadmouri, A., Senesse, P., Seys, P., Radji, A., … & Dufour, P. (2014). Home parenteral nutrition improves quality of life and nutritional status in patients with cancer: a French observational multicentre study. Supportive care in cancer, 22(7), 1867-1874.

Davey, A., Chilcot, J., Driscoll, E., & McCracken, L. M. (2020). Psychological flexibility, self-compassion and daily functioning in chronic pain. Journal of contextual behavioral science, 17, 79-85.

Dochat, C., Wooldridge, J. S., Herbert, M. S., Lee, M. W., & Afari, N. (2021). Single-session acceptance and commitment therapy (ACT) interventions for patients with chronic health conditions: A systematic review and meta-analysis. Journal of contextual behavioral science, 20, 52-69.

Dowd, A. J., & Jung, M. E. (2017). Self-compassion directly and indirectly predicts dietary adherence and quality of life among adults with celiac disease. Appetite, 113, 293-300.

Du, S., Dong, J., Jin, S., Zhang, H., & Zhang, Y. (2021). Acceptance and Commitment Therapy for chronic pain on functioning: A systematic review of randomized controlled trials. Neuroscience & Biobehavioral Reviews, 131, 59-76.

Edwards, D. J. (2019). Age, pain intensity, values-discrepancy, and mindfulness as predictors for mental health and cognitive fusion: hierarchical regressions with mediation analysis. Frontiers in Psychology, 10, 517.

El-Dallal, M., Saroufim, A., Systrom, H., Ballou, S., Farhoud, A., Pasam, R. T., … & Cheifetz, A. (2022). Assessing the repercussions of COVID-19 pandemic on symptoms, disease management, and emotional well-being in patients with inflammatory bowel disease: a multi-site survey study. Scandinavian Journal of Gastroenterology, 57(4), 406-414.

Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods, 41(4), 1149-1160.

Field, A. (2013). Discovering statistics using IBM SPSS statistics. Sage.

Fiese, B. H., Wamboldt, F. S., & Anbar, R. D. (2005). Family asthma management routines: Connections to medical adherence and quality of life. The Journal of pediatrics, 146(2), 171-176.

Francis, A. W., Dawson, D. L., & Golijani-Moghaddam, N. (2016). The development and validation of the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT). Journal of contextual behavioral science, 5(3), 134-145.

Friis, A. M., Johnson, M. H., Cutfield, R. G., & Consedine, N. S. (2016). Kindness matters: a randomized controlled trial of a mindful self-compassion intervention improves depression, distress, and HbA1c among patients with diabetes. Diabetes care, 39(11), 1963-1971.

Fryback, D. G., Dunham, N. C., Palta, M., Hanmer, J., Buechner, J., Cherepanov, D., … & Ganiats, T. G. (2007). US norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Medical care, 45(12), 1162.

Gavrilescu, O., Prelipcean, C. C., Dranga, M., Popa, I. V., & Mihai, C. (2022). Impact of COVID-19 Pandemic on the Quality of Life of IBD Patients. Medicina, 58(5), 562.

Gilbert, P. (2014). The origins and nature of compassion focused therapy. British journal of clinical psychology, 53(1), 6-41.

Girke, J., Seipt, C., Markowski, A., Luettig, B., Schettler, A., Momma, M., & Schneider, A. S. (2016). Quality of life and nutrition condition of patients improve under home parenteral nutrition: an exploratory study. Nutrition in Clinical Practice, 31(5), 659-665.

Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of contextual behavioral science, 18, 181-192.

Graham, C. D., Gouick, J., Ferreira, N., & Gillanders, D. (2016a). The influence of psychological flexibility on life satisfaction and mood in muscle disorders. Rehabilitation psychology, 61(2), 210.

Graham, C. D., Gouick, J., Krahé, C., & Gillanders, D. (2016b). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical psychology review, 46, 46-58.

Hann, K. E., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. Journal of contextual behavioral science, 3(4), 217-227.

Harrison, A., Scott, W., Timmins, L., Graham, C. D., & Harrison, A. M. (2021). Investigating the potentially important role of psychological flexibility in adherence to antiretroviral therapy in people living with HIV. AIDS care, 33(3), 337-346.

Hayes, A. F., & Cai, L. (2007). Using heteroskedasticity-consistent standard error estimators in OLS regression: An introduction and software implementation. Behavior research methods, 39(4), 709-722.

Hayes, B., Apputhurai, P., Mikocka-Walus, A., Barreiro-de Acosta, M., Bernstein, C. N., Burgell, R., … & Graff, L. A. (2021). Extending the common sense model to explore the impact of the fear of COVID-19 on quality of life in an international inflammatory bowel disease cohort. Journal of clinical psychology in medical settings, 1-11.

Hayes, S., Strosahl, K., & Wilson, K. (2011a). Acceptance and Commitment Therapy: Second addition, the process and practice of mindful change. New york: Gulford.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25.

Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011b). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual review of clinical psychology, 7, 141-168.

Henry, J. D., & Crawford, J. R. (2005). The short‐form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. British journal of clinical psychology, 44(2), 227-239.

Huber, P. J. (1981). Robust statistics. John Wiley & Sons, Inc.

Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain. The Clinical journal of pain, 33(6), 552-568.

Huisman-de Waal, G., Schoonhoven, L., Jansen, J., Wanten, G., & van Achterberg, T. (2007). The impact of home parenteral nutrition on daily life—a review. Clinical Nutrition, 26(3), 275-288.

Huisman‐de Waal, G., Versleijen, M., Van Achterberg, T., Jansen, J. B., Sauerwein, H., Schoonhoven, L., & Wanten, G. (2011). Psychosocial complaints are associated with venous access–device related complications in patients on home parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 35(5), 588-596.

Iida, H., Fujimoto, S., Wakita, T., Yanagi, M., Suzuki, T., Koitabashi, K., … & Shibagaki, Y. (2020). Psychological flexibility and depression in advanced CKD and dialysis. Kidney medicine, 2(6), 684-691. e681.

Kaiser, H. F. (1974). An index of factorial simplicity. psychometrika, 39(1), 31-36.

Kılıç, A., Hudson, J., McCracken, L. M., Ruparelia, R., Fawson, S., & Hughes, L. D. (2021). A systematic review of the effectiveness of self-compassion-related interventions for individuals with chronic physical health conditions. Behavior therapy, 52(3), 607-625.

Kılıç, A., Hudson, J., Scott, W., McCracken, L. M., & Hughes, L. D. (2022). A 12-month longitudinal study examining the shared and unique contributions of self-compassion and psychological inflexibility to distress and quality of life in people with Type 2 Diabetes. Journal of Psychosomatic Research, 155, 110728.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613.

Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy, 33(3), 335-343.

MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical psychology review, 32(6), 545-552.

Maor, M., Zukerman, G., Amit, N., Richard, T., & Ben-Itzhak, S. (2021). Psychological well-being and adjustment among type 2 diabetes patients: the role of psychological flexibility. Psychology, Health & Medicine, 1-12.

Marshall, E.-J., & Brockman, R. N. (2016). The relationships between psychological flexibility, self-compassion, and emotional well-being. Journal of Cognitive Psychotherapy, 30(1), 60-72.

McCracken, L. M., Yu, L., & Vowles, K. E. (2022). New generation psychological treatments in chronic pain. bmj, 376, e057212.

McCulloch, A., Jones, I., Fletcher, J., Malhi, H., & Cooper, S. C. (2022). Experiences of the COVID-19 pandemic: A survey of patients on home parenteral nutrition. Clinical nutrition ESPEN, 50, 334–337.

Miller, T. L., Greene, G. W., Lofgren, I., Greaney, M. L., & Winkler, M. F. (2017). Content Validation of a Home Parenteral Nutrition–Patient‐Reported Outcome Questionnaire. Nutrition in Clinical Practice, 32(6), 806-813.

Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical care, 67-74.

Muris, P., & Petrocchi, N. (2017). Protection or vulnerability? A meta‐analysis of the relations between the positive and negative components of self‐compassion and psychopathology. Clinical psychology & psychotherapy, 24(2), 373-383.

Neff, K. (2003a). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101.

Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223-250.

Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self‐compassion program. Journal of clinical psychology, 69(1), 28-44.

Ng Fat, L., Scholes, S., Boniface, S., Mindell, J., & Stewart-Brown, S. (2017). Evaluating and establishing national norms for mental wellbeing using the short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS): findings from the Health Survey for England. Quality of life Research, 26(5), 1129-1144.

Nicholas, J. A., Yeap, B. B., Cross, D., & Burkhardt, M. S. (2021). Psychological flexibility is associated with less diabetes distress and lower glycated haemoglobin in adults with type 1 diabetes. Internal Medicine Journal.

Persoon, A., Huisman-de Waal, G., Naber, T. A., Schoonhoven, L., Tas, T., Sauerwein, H., & van Achterberg, T. (2005). Impact of long-term HPN on daily life in adults. Clinical Nutrition, 24(2), 304-313.

Pironi, L., Boeykens, K., Bozzetti, F., Joly, F., Klek, S., Lal, S., … & Wanten, G. (2020). ESPEN guideline on home parenteral nutrition. Clinical Nutrition, 39(6), 1645-1666.

Pyszkowska, A., & Rönnlund, M. (2021). Psychological flexibility and self-compassion as predictors of well-being: Mediating role of a balanced time perspective. Frontiers in Psychology, 12, 2110.

Qualtics. (2021). Qualtrics.

Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self‐compassion scale. Clinical psychology & psychotherapy, 18(3), 250-255.

Rose, M., Graham, C. D., O'Connell, N., Vari, C., Edwards, V., Taylor, E., … & Norton, S. (2022). A randomised controlled trial of acceptance and commitment therapy for improving quality of life in people with muscle diseases. Psychological medicine, 1-14.

Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological bulletin, 143(8), 783.

Schliefert, E., & Carey, S. (2013). Nutritional status and quality of life in a cohort of A ustralian home parenteral nutrition patients: A pilot study. Nutrition & Dietetics, 71(2), 79-85.

Sempere, L., Bernabeu, P., Cameo, J., Gutierrez, A., Laveda, R., García, M. F., … & Ruiz-Cantero, M. T. (2022). Evolution of the emotional impact in patients with early inflammatory bowel disease during and after Covid-19 lockdown. Gastroenterología y Hepatología, 45(2), 123-133.

Shah, N., Cader, M., Andrews, B., McCabe, R., & Stewart-Brown, S. L. (2021). Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): performance in a clinical sample in relation to PHQ-9 and GAD-7. Health and quality of life outcomes, 19(1), 1-9.

Sirois, F. M. (2020). The association between self-compassion and self-rated health in 26 samples. BMC public health, 20(1), 1-12.

Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (2015). Self-compassion, stress, and coping in the context of chronic illness. Self and Identity, 14(3), 334-347.

Skevington, S. M., Lotfy, M., & O'Connell, K. A. (2004). The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of life Research, 13(2), 299-310.

Skevington, S. M., & McCrate, F. M. (2011). Expecting a good quality of life in health: assessing people with diverse diseases and conditions using the WHOQOL‐BREF. Health Expectations, 15(1), 49-62.

Souza, L. K. d., & Hutz, C. S. (2016). Self-compassion in relation to self-esteem, self-efficacy and demographical aspects. Paidéia (Ribeirão Preto), 26, 0181-0188.

Sowerbutts, A. M., Jones, D., Lal, S., & Burden, S. (2021). Quality of life in patients and in family members of those receiving home parenteral support with intestinal failure: A systematic review. Clinical Nutrition, 40(5), 3210-3220.

Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J., & Weich, S. (2009). Internal construct validity of the Warwick-Edinburgh mental well-being scale (WEMWBS): a Rasch analysis using data from the Scottish health education population survey. Health and quality of life outcomes, 7(1), 1-8.

Stirratt, M. J., Dunbar-Jacob, J., Crane, H. M., Simoni, J. M., Czajkowski, S., Hilliard, M. E., … & Huntley, K. (2015). Self-report measures of medication adherence behavior: recommendations on optimal use. Translational behavioral medicine, 5(4), 470-482.

Theilla, M., Kagan, I., Chernov, K., Cohen, J., Kagan, I., & Singer, P. (2017). Self‐evaluation of quality of life among patients receiving home parenteral nutrition: a validation study. Journal of Parenteral and Enteral Nutrition, 42(3), 516-521.

Trindade, I. A., & Ferreira, N. B. (2021). COVID-19 Pandemic’s effects on disease and psychological outcomes of people with inflammatory bowel disease in Portugal: A preliminary research. Inflammatory bowel diseases, 27(8), 1224-1229.

Tsang, P. Y., & Carey, S. (2015). Impact of home parenteral nutrition on daily life: a qualitative study of eight patients. Nutrition & Dietetics, 72(1), 16-21.

Tyndall, I., Waldeck, D., Pancani, L., Whelan, R., Roche, B., & Dawson, D. L. (2019). The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity. Journal of contextual behavioral science, 12, 278-284.

Vivek, P. H., Singh, S. N., Mishra, S., & Donavan, D. T. (2017). Parallel Analysis Engine to Aid in Determining Number of Factors to Retain using R [Computer software]. Retrieved 23 March 2022 from

Whoqol Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological medicine, 28(3), 551-558.

Wilburn, J., McKenna, S. P., Heaney, A., Rouse, M., Taylor, M., Culkin, A., … & Lal, S. (2018). Development and validation of the Parenteral Nutrition Impact Questionnaire (PNIQ), a patient-centric outcome measure for Home Parenteral Nutrition. Clinical Nutrition, 37(3), 978-983.

Wilson, J. M., Weiss, A., & Shook, N. J. (2020). Mindfulness, self-compassion, and savoring: Factors that explain the relation between perceived social support and well-being. Personality and Individual Differences, 152, 109568.

Winkler, M. F. (2005). Quality of life in adult home parenteral nutrition patients. Journal of Parenteral and Enteral Nutrition, 29(3), 162-170.

Winkler, M. F., Hagan, E., Wetle, T., Smith, C., Maillet, J. O. S., & Touger‐Decker, R. (2010). An exploration of quality of life and the experience of living with home parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 34(4), 395-407.

Winkler, M. F., & Smith, C. E. (2014). Clinical, social, and economic impacts of home parenteral nutrition dependence in short bowel syndrome. Journal of Parenteral and Enteral Nutrition, 38(1 Suppl), 32S-37S.

Wolgast, M. (2014). What does the Acceptance and Action Questionnaire (AAQ-II) really measure? Behavior therapy, 45(6), 831-839.

World Health Organization. (1996). WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996.

Wynne, B., McHugh, L., Gao, W., Keegan, D., Byrne, K., Rowan, C., … & Cullen, G. (2019). Acceptance and commitment therapy reduces psychological stress in patients with inflammatory bowel diseases. Gastroenterology, 156(4), 935-945. e931.

Xue, Z., Coughlin, R., Amorosa, V., Quinn, R., Schiavone, P., Stoner, N., … & Compher, C. (2020). Factors Associated With Central Line–Associated Bloodstream Infections in a Cohort of Adult Home Parenteral Nutrition Patients. Journal of Parenteral and Enteral Nutrition, 44(8), 1388-1396.

Yadavaia, J. E., Hayes, S. C., & Vilardaga, R. (2014). Using acceptance and commitment therapy to increase self-compassion: A randomized controlled trial. Journal of contextual behavioral science, 3(4), 248-257.

Yarnell, L. M., Stafford, R. E., Neff, K. D., Reilly, E. D., Knox, M. C., & Mullarkey, M. (2015). Meta-analysis of gender differences in self-compassion. Self and Identity, 14(5), 499-520.

Zessin, U., Dickhäuser, O., & Garbade, S. (2015). The relationship between self‐compassion and well‐being: A meta‐analysis. Applied Psychology: Health and WellBeing, 7(3), 340-364.



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