An eight-week online compassion program helped adults living with chronic conditions report better quality of life, suggesting that psychological support may be delivered beyond the therapy room, although high dropout rates mean the findings need confirmation.

Study: Internet Attachment–Based Compassion Therapy for Adults With Chronic Medical Conditions: Randomized Controlled Trial. Image Credit: Lucigerma / Shutterstock

A fully self-guided, internet-delivered attachment-based compassion intervention may improve quality of life in adults with chronic health conditions, according to a new study published in the Journal of Medical Internet Research.

Background

The prevalence of chronic diseases, such as obesity, hypertension, type 2 diabetes, gastritis, and thyroid disease, is increasing, imposing major challenges to the global healthcare system.

The widespread coexistence of mental health problems with chronic physical illnesses substantially affects the quality of life of patients, their family members, and societal structures in a broader sense.

This complex coexistence suggests a bidirectional relationship, where comorbid psychological conditions play a crucial role in shaping chronic disease outcomes, including disease progression, treatment response, and rates of morbidity and mortality.

Negative psychological factors, such as disease-related shame, self-criticism, or rumination, significantly limit self-care behaviors involved in disease management, including adherence to treatment and lifestyle guidelines. These shortcomings subsequently increase distress, affect quality of life, and worsen disease prognosis.

Compassion-based interventions have shown promise in improving disease management by encouraging patients to accept their suffering as a fundamental human experience and to develop a gentler attitude toward personal challenges.

Among various compassion-based interventions, attachment-based compassion therapy (ABCT) is considered to be a particularly promising approach that has shown effectiveness in people with chronic medical conditions and accompanying psychological challenges.

This intervention is based on attachment theory, which provides a framework for understanding the link between close relationships and psychopathology and includes specific practices to identify and develop a secure attachment style to promote compassion for oneself and others.

Despite documented effectiveness, accessibility challenges potentially restrict the widespread implementation of ABCT. An online version of ABCT, termed internet attachment-based compassion therapy (iABCT), has been developed to overcome accessibility challenges while maintaining the core therapeutic approach. Currently, iABCT is available as a fully self-administered internet intervention for Spanish speakers.

The current study aimed to evaluate the efficacy of internet ABCT in improving quality of life, well-being, and other psychological outcomes in adults with chronic medical conditions.

Study design

The study included 146 adult participants in Spain who were randomly assigned to either the internet ABCT group or the control group. The internet ABCT intervention comprised 8 modules that were delivered online over an 8-week period. A waiting-list group was selected as the control to compare with the initial effectiveness of internet ABCT before comparing with active treatment alternatives.

Participants’ quality of life, well-being, and other psychological parameters were assessed at baseline and at 3- and 6-month follow-ups. The control group received access to the intervention after completing the 3-month assessment. Although all 146 randomized participants were included in intention-to-treat analyses, follow-up data at 3 months were available for 27 intervention and 26 control participants.

Key findings

The 3-month assessment revealed a significant improvement in overall quality of life among participants in the iABCT group compared with the control group. In the iABCT group, participants experienced significant improvements in overall quality of life and general health at the 3-month follow-up compared with baseline. However, no such improvement was observed in the control group. General health did not differ significantly between the groups at 3 months.

Regarding overall well-being, total and remembered well-being improved differently over time between the groups, but direct comparisons between the groups at 3 months were not statistically significant. Within the iABCT group, total and remembered well-being improved from baseline, while no significant change was observed in the control group.

Among the tested psychological outcomes, preoccupied attachment showed a significantly greater reduction in the iABCT group than in the control group. Preoccupied attachment refers to an insecure relationship style generally associated with fear of rejection or abandonment and a strong need for reassurance.

The improvement in quality of life observed in the iABCT group at 3-month follow-up was also evident at 6-month follow-up. However, no untreated control comparison was possible at 6 months because the waiting-list group had already received the intervention.

Regarding treatment acceptability, most participants who completed the intervention in both groups reported high satisfaction and usability. A lack of therapist contact and insufficient monitoring were identified as key barriers to engagement.

Study significance

The study provides preliminary evidence that a fully self-guided, internet-delivered ABCT may improve overall quality of life and reduce preoccupied attachment among adults with chronic diseases. Within the iABCT group, improvements in self-compassion, self-criticism, psychological symptoms, and attachment styles were maintained at 6 months, although these longer-term findings lacked a comparison with an untreated control group.

These findings suggest that the intervention may help address participants’ emotional and psychological responses to the disease burden by encouraging acceptance of suffering, promoting adaptive coping, and reducing self-blame behaviors. However, most secondary outcomes, including self-compassion, self-criticism, self-care behaviors, psychological symptoms, and social support, did not show significant differences between groups at 3 months.

Face-to-face ABCT has previously shown psychological benefits, including large effects in studies of patients with fibromyalgia, while broader evidence supports compassion-based interventions across chronic conditions. The current study findings extend this evidence to a fully self-guided digital format and suggest that internet ABCT could represent a potentially viable alternative to face-to-face delivery, although the two formats were not directly compared.

In contrast to the observed improvement in quality of life among participants receiving the internet ABCT, the study found no significant between-group difference in well-being at 3 months.

Chronic diseases are associated with high comorbidity rates and progressive functional limitations over time. A patient’s well-being may be more sensitive to these physical health fluctuations than quality of life, which the authors suggest may partly explain the absence of a statistically significant between-group difference in well-being and the lack of sustained well-being gains at 6 months.

Overall, the study provides preliminary evidence that iABCT may improve quality of life while potentially addressing access barriers related to geographical distance, mobility, or socioeconomic constraints.

The researchers advised considering these findings as exploratory, given the high attrition, modest sample size, and absence of an active control. The waiting-list design may also have overestimated treatment effects, and no adjustment was prespecified for multiple primary and secondary outcomes, increasing the possibility of false-positive findings. The predominantly female, Spanish-speaking, and highly educated sample further limits generalizability.

Future studies considering active control conditions, adequately powered samples, appropriate correction for multiple outcomes, minimal human support, and cost-effectiveness analyses are needed to optimize real-world implementation.

Journal reference:

• Herrero R, et al.2026. Internet Attachment-Based Compassion Therapy for Adults With Chronic Medical Conditions: Randomized Controlled Trial. Journal of Medical Internet Research. https://www.jmir.org/2026/1/e86679/