Addressing Existential Distress Through Compassion: Feasibility and Preliminary Effects of Compassion With You...

Cancer-related distress extends beyond anxiety and depression to existential suffering, including loss of meaning, helplessness, uncertainty, and relational strain. Compassion-based interventions in psycho-oncology are promising, but existential outcomes such as demoralization and spiritual well-being have rarely been examined. Compassion With You (COMwithU) is a brief, five-session compassion-based intervention that centers on cultivating self-compassion, supported by the therapist's compassionate presence and by practices of extending compassion toward others.

This single-arm feasibility study evaluated COMwithU in adult patients with cancer using a pre-post-1-month follow-up design. The intervention comprised five individual 60-min sessions delivered in person or via videoconferencing. Primary outcomes were feasibility and acceptability. Secondary outcomes included anxiety, depression, spiritual well-being, demoralization, self-compassion, and intolerance of uncertainty. Linear mixed models examined changes across baseline, post-intervention, and follow-up.

Of 44 participants who started the intervention, 37 attended at least 3 of 5 sessions, yielding a completion rate of 84.1%. Among 34 full completers, 31 (91.2%) completed the post-intervention assessment, and 30 (88.2%) completed the follow-up. Helpfulness was rated highly (mean 4.63/5). Anxiety, depression, spiritual well-being, demoralization, and self-compassion improved significantly, whereas intolerance of uncertainty did not change significantly. Among participants above the demoralization cutoff at baseline, 68.0% showed reliable improvement, and 56.0% achieved clinically significant change by follow-up.

COMwithU demonstrated good feasibility, high acceptability, and promising preliminary effects in patients with cancer. The strongest effects were observed for demoralization and spiritual well-being. Further randomized controlled trials should directly assess self-compassion, relational compassion processes, and existential outcomes.

This study was registered at the Clinical Research Information Service (CRIS), Republic of Korea (Registration number: KCT0010315).