Beyond Macros and Weight Loss: Promoting Flourishing Health with Comprehensive Coaching


What is your role as a coach?


There seems to be a lingering perception in the fitness industry that the role of a coach is limited to helping someone achieve their body composition or performance goals. Whilst there isn’t anything inherently wrong with this, there is certainly more scope to improve the health of the individuals we work with. Comprehensive Coaching seeks to promote Flourishing Health, which includes one’s physical, social, psychological and philosophical health [1], to facilitate growth across different domains of life.


In addition to potential body composition changes and performance enhancement, a Comprehensive Coach will consider:

  1. Reducing dysfunctional behaviours and cognitions such as disordered eating, negative body image, psychological inflexibility and experiential avoidance, while

  2. Promoting functional behaviours and cognitions, such as a positive body image; behavioural commitment to clearly-defined values; metacognitive awareness of decision-making processes; psychological flexibility; and self-compassion.

When we understand the conditions people need to thrive, we can identify and target important variables amenable to improvement, thus catalysing positive change.


Flourishing Health

To flourish means to grow and prosper across different domains of life. Flourishing Health expands far beyond the physical domain to include one’s social, psychological and philosophical wellbeing. It is a comprehensive consideration of all of the factors that may influence one’s experience of health and wellbeing. This perspective of healthy functioning includes meaningful connections with others, mental wellbeing, self-efficacy, autonomy, resilience and a sense of meaning and coherence, amongst other things. Subsequently, health-seeking behaviours include not only eating vegetables and exercising, but also spending time with loved ones, managing stress levels, building confidence and developing a clear sense of direction.





It has been suggested that the absence of mental illness is not necessarily reflective of genuine mental health and that languishing, which is common, is also associated with considerable psychosocial impairment [2]. Inspired by this notion, Flourishing Health views health as a positive state, an expanding strength that is constantly achieved, and not simply a background operation of a well-functioning system. Moreover, flourishing in life could be a source of resilience, acting as a stress buffer against stressful events and life transitions.


We may consider Flourishing Health promotion from two perspectives: reducing aspects of maladaptive functioning, and promoting aspects of adaptive functioning. Six dimensions of psychological well-being are proposed: self-acceptance, positive relations with others, personal growth, purpose in life, environmental mastery, and autonomy [3]. Individuals who function well are comfortable with most parts of themselves, have warm and trusting relationships, see themselves developing into better people, have a direction in life, are able to shape their environments to satisfy their needs, and have a degree of self-determination. Taking care of one’s physical health is merely one aspect of achieving adaptive functioning; psychological, social and environmental factors play a role too.


Addressing Maladaptive Functioning


Addressing Disordered Eating

Given the conspicuous links between body weight, body dissatisfaction, eating-disordered behavior and mental health, and the fact that disordered-eating behaviours appear to be increasing [4], it is pertinent for coaches to be cognisant of the behavioural and attitudinal red flags that clients may display. Subclinical eating pathologies may affect a large subset of individuals and research has indicated that, in many cases, these individuals do not differ significantly from those receiving a diagnosis of anorexia nervosa or bulimia nervosa in terms of how distressing the symptoms can be and how they affect quality of life [5]. Eating disorder risk factors and behaviours, such as body image concerns and disordered eating, are associated with significant health impairments and are robust predictors of eating disorder onset [6]. Early intervention is thought to reduce the likelihood that an individual with subclinical eating pathology will develop a clinical eating disorder and can help to improve quality of life [7]. Crucially, a large number of individuals struggle to spot disordered eating behaviours in themselves [8] and those high at risk are less likely to reach out for help [9]. As coaches, it is our responsibility to be aware of this.



Symptoms of disordered eating may include obsessive thinking about food and appearance, restriction, repetitive shape checking, fasting or skipping meals, compulsive exercise, chronic dieting, obsessive calorie counting, anxiety around eating out, viewing foods as good or bad, fear of fat gain, feeling anxious without a plan, and a lack of flexibility. We can help clients to move towards more flexible and adaptable styles of eating by considering the context and circumstances under which dietary restraint is employed, methods of self-evaluation and self-regulation, and individual differences in eating disorder risk [10].

Reducing Negative Body Image

Body dissatisfaction is defined as a subjective negative evaluation of body size, shape, muscularity/muscle tone, and weight [11], and is associated with poorer mental and physical health-related quality of life [12], independent of its association with body weight or eating disorder symptoms [13].


Body image attitudes are comprised of:

  • Appearance evaluations - one's beliefs and appraisals (e.g., satisfaction or dissatisfaction) regarding their body, and

  • Appearance investment - the cognitive, behavioral, and emotional importance of an individual’s body in relation to their sense of self-worth [14].

Individuals with a negative body image tend to have negative thoughts (e.g., “I’m extremely unattractive”), feelings (e.g., weight dissatisfaction), and perceptions (e.g., magnification of perceived ‘flaws’) about their own body, and engage in behaviours such as excessive mirror-checking, pinching of the skin, or avoidance of public situations.


Due to its prevalence and impact on one’s quality of life, body dissatisfaction is considered a public health concern [15]. Given the link between negative body image and the development of eating disorders [16], and the fact that many clients have body composition goals, it is crucial to understand a client’s body image attitudes and the motivations behind their goals.


The cognitive model best describes body image disturbance (BID) in a nonclinical sample, implicating maladaptive cognitions in the development of BID and supporting the application of cognitive strategies to target dysfunctional beliefs [17]. Some of these beliefs may include ‘I would enjoy life more if I looked the way I wished’, ‘My appearance influences my ability to do things’, or ‘People will think less of me if I don’t look my best’ [18]. When a client engages in intentional weight loss for appearance modification, understanding and addressing their appearance beliefs may be an important part of improving a negative body image.



Alongside targeting beliefs such as body-related perfectionism, importance of appearance and uncertainty about one's looks, additional steps to reduce a negative body image may include: reducing over-reliance of self-esteem on one's appearance [19]; shape checking [20] and appearance comparisons [21]; labeling experiences when one experiences feelings of fatness [22]; and reducing focus on weight and shape by putting energy into other areas in one’s life [23].


Addressing Experiential Avoidance

The Acceptance and Commitment Therapy (ACT) approach posits that psychological human suffering is due to a lack of behavioral flexibility and effectiveness, which emerges from experiential avoidance, cognitive entanglement, difficulty with perspective taking, loss of contact with the present, and failure to take needed behavioral steps in accord with core values - this is termed psychological inflexibility [24]. Experiential avoidance (EA), behavior that attempts to alter the frequency or form of unwanted private events, including thoughts, memories, and bodily sensations [25], has been associated with a wide variety of negative outcomes [26], including poorer physical health [27] and lower quality of life [28], and seems to describe a pattern of adjustment seen in those unable to maintain weight loss [29].


The Multidimensional Experiential Avoidance Questionnaire identified six factors of EA, including behavioral avoidance, distress aversion, procrastination, distraction/suppression, repression/denial, and distress endurance [30]. Individuals high in EA are more likely to engage in avoidance behaviors when a distressing situation arises or is anticipated, such as skipping the gym due to anxieties about being watched, or distracting oneself from sadness by comfort eating.


‘Pain in this life is not avoidable, but the pain we create avoiding pain is avoidable’ - R.D.Laing


A Comprehensive Coach can help a client identify when experientially avoidant behaviours create obstacles to the goals they wish to achieve. The pros and cons of both avoidance and overcoming avoidance may be examined to explore the client’s motivation to reduce these behaviours. Change talk may be elicited from the client: statements of desire, ability, reasons to and need to overcome avoidance [31]. This may open the floor to work on increasing willingness and building distress tolerance skills, helping a client to take committed action towards their goals in spite of uncomfortable internal experiences.


Promoting Positive Functioning


Promoting Positive Body Image

A positive body image is qualitatively distinct from a negative body image, meaning that absence of a negative body image doesn’t necessarily predict a positive one [32]. Rather, a positive body image is something we actively strive towards. Positive body image is defined as: favorable opinions of the body regardless of actual physical appearance; acceptance of the body despite incongruences with media appearance ideals; respect toward the body by tending to its needs and engaging in healthy behaviors; and protection of the body by rejecting unrealistic appearance ideals [33]. A positive body image is uniquely associated with well-being: individuals with a positive body image report fewer depressive symptoms, higher self-esteem, fewer unhealthy dieting behaviours, and greater intentions to protect one’s skin from UV exposure and damage [34]. These findings occurred independently of BMI meaning that, regardless of actual body size, those who have higher positive body image experience better physical and mental health outcomes.


Fostering a positive body image can serve as a protective factor that disrupts body image-related variables implicated in the etiology of eating pathology [35], namely thin-ideal internalization, self-objectification, poor interoceptive awareness, body or appearance comparisons, body dissatisfaction, and drive for thinness [36]. A positive body image can serve as a protective filter against the many body image threats that may be experienced on a daily basis, such as direct and indirect appearance‐related pressures from peers, family, partners, society, and the media [37], being sexually objectified [38], or being told to ignore internal self‐regulatory hunger and satiety cues [39]. Those with a higher positive body image are also more likely to engage in self-care behaviors such as exercise, yoga, meditation, or unwinding by reading novels [40].


Strategies to promote a positive body image include: increasing body appreciation [41], body acceptance [42] and body image flexibility [43]; promoting a broad conceptualisation of beauty [44]; engaging in mindful self care [45]; and practicing self-compassion [46] and gratitude [47]. For a more comprehensive approach to improving a client’s body image, see the Body Image Webinar series.

Promoting Psychological Flexibility

Psychological flexibility is the ability to defuse from difficult thoughts and accept difficult feelings while persisting in values-based action [48]. It is defined in terms of six processes or factors: acceptance of experience, cognitive defusion, contact with the present moment, contextual self, life values and actions linked to chosen values. It has been suggested that psychological flexibility may be a fundamental aspect of health, since it enables one to recognise and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values [49]. ACT could be useful as an add-on treatment, or in a combined format, for improving long-term weight loss outcomes [50]. Coping with unwanted cognitive and emotional experiences seems to play a vital role in predicting long-term weight loss success.


Body image-flexibility, a specific type of psychological flexibility relevant to the context of eating and body image, is the capacity to experience and accept unwanted thoughts and feelings regarding the body so that one is able to engage in value-consistent action despite being concerned about body size, weight, or shape [51], and constitutes an adaptive strategy in managing distressing cognitions [52]. Diminished levels of body image flexibility and attempts to avoid aversive ideas related to the body have been associated with enhanced eating disorder psychopathology as well as reduced body appreciation among non-clinical samples [53]. A recent meta-analysis found strong evidence that body image flexibility is connected to various adaptive psychological processes, including lower levels of eating, body image, and mental health disturbances, and higher levels of positive body-related and general psychology constructs [54].


Psychological inflexibility has also been associated with eating-related difficulties. Dietary restraint seems to be a complex construct that involves distinct facets and that cannot be categorized as entirely beneficial or detrimental [55], yet rigid adherence to restrictive eating rules is associated with increased concerns about eating and pathological dietary behaviours [56].


The Inflexible Eating Questionnaire (IEQ) is a self-report measure designed to capture psychological inflexibility focused on eating, involving:

  1. The inflexible adherence to eating rules, without meeting internal (e.g., hunger or satiety cues) or external (e.g., certain social contexts) contingencies

  2. A sense of control when meeting such rules; and

  3. Distress when perceiving failures in meeting such rules [57].


The IEQ presented significant associations with dietary restraint, eating psychopathology, body image inflexibility, general psychopathology symptoms, and decreased intuitive eating. On the other hand, an increase in flexible cognitive restraint is related to better weight loss maintenance and wellbeing [58]. These findings suggest that flexible eating attitudes and behaviours are fundamental to positive physical and psychological functioning.

Values-Clarification

Values are statements about how you want to behave or act on an ongoing basis; how you want to treat yourself, others, the world around you [59]. They can be regarded as an autonomous motivation framework for living a complete, whole life. Values are distinct from goals, in that they cannot be ‘checked off’ a list. Rather, values establish the direction you want your life to head and goals serve as markers to help you navigate and let you know whether you’re still on course. Engaged living (defined as the evaluation and performance of valued life activities) has been empirically associated with decreased psychological distress, higher levels of life fulfillment, and improvements in psychological quality of life [60].

Some of the most common reasons for dieting are to lose weight, look better, and build confidence [61]. Unfortunately, being motivated in one’s dietary choices by mood or by weight control leads to pretty poor outcomes in the long term [62]. An Acceptance and Commitment Therapy (ACT)-based values-clarification exercise may be an effective way to determine more intrinsic reasons to change and ensure that one’s goals are in service of the things that are truly important to them. This may help to improve one’s motivation to change [63] and shift some of the focus to health, a motivator associated with longer term success [64].

Values-clarification can also help to guide goal setting, by translating one’s values to concrete and small behaviours that incorporate a valued path [65]. Being sensitive to contextual cues, this process allows one to change and stop a behaviour when it is inconsistent with their chosen values. This may help clients let go of problematic behaviours that aren’t serving them, such as inflexible eating rules, dieting or body checking, and take committed action towards what is truly important to them. Committed action is persistent, even when the engagement in valued behaviours might trigger or increase uncomfortable experiences. Having a clear idea of one’s values can provide a basis for willingness to do the uncomfortable work of letting go of avoidant behaviours.

Increasing Meta-Cognitive Awareness

Nutritional education may form an important part of coaching, but a knowledge-deficit is very rarely the largest obstacle to changing one’s eating behaviours [66]. Oftentimes, clients will feel like they ‘know what to do, but just can’t stick to it’. Perhaps it’s not a lack of nutritional awareness, but a lack of self-awareness that’s the missing piece. Increasing in the moment awareness of how a client is feeling, thinking and behaving may help clients identify the why behind their eating and body-related behaviours, opening up avenues for change.

Sometimes the barriers to change are internal. Shame [67], self-criticism [68], internalised stigma [69], difficult emotions [70], psychological inflexibility [71], and body dissatisfaction [72] present obstacles to pursuing health-seeking behaviours and may increase engagement in health-risk behaviours. Food-related cues may also be internal, such as different emotional states that trigger hunger or prompt someone to eat [73]. For example, negative affect has been linked with increased appetite and unhealthy snack choices [74]. Further, negative emotions such as anger, fear, and sadness have been associated with increased impulsive eating and the consumption of unhealthy foods, perhaps due to impaired cognitive control over eating leading to increased snack consumption [75]. Finally, some research indicates that negative affect may influence food intake when it is used as a coping strategy to distract oneself from stress [76], particularly in those with high cortisol reactivity levels [77].


Stress can impact health directly through autonomic and neuroendocrine processes [78] and, alarmingly, it is not just the presence of physical stressors that induces the physiological stress response. The perseverative cognition hypothesis proposes that cognitive representation, particularly rumination [79], is enough to increase susceptibility to stress-related ill-health [80]. Stress can also impact health indirectly, by influencing engagement in health-seeking behaviours. Research supports associations between stress and poorer sleep outcomes [81], greater alcohol consumption [82], unhealthy eating behaviors [83], and less physical activity [84]. Support for additional indirect pathway between perseverative cognition and health outcomes has via reduced engagement in physical activity has also been found [85].

Increasing one’s meta-cognitive awareness can bring to light these issues and foster insight, the conscious process of making novel connections [86], to help clients understand their own thoughts, feelings and behaviours. Once an individual is more aware of these habitual reactions, they may be able to relate to themselves in a new way, and develop tools to interrupt the cycle, thus increasing their behavioural repertoire.

Specific research on emotion regulation indicates that attempting to change/control momentary negative affect reduces blood glucose levels, which consequently reduces performance on subsequent self-regulation tasks [87]. Therefore acceptance-based strategies may be effective to help clients persist in values-based health-seeking behaviours in the presence of negative internal stimuli.


Mindfulness, deliberately paying attention to the present moment experiences with an attitude of non-judgemental awareness [88], is an object of much scrutiny in the evidence-based fitness community, perhaps due to its phenomenological origins in Eastern traditions and questions about the defining characteristics of mindfulness. Although much of the field has proceeded in the absence of an operational definition [89], and most reviewed meditation studies have several key methodological shortcomings which preclude robust conclusions [90], mindfulness in contemporary psychology has been adopted as an approach for increasing awareness and responding skillfully to mental processes that contribute to emotional distress and maladaptive behaviour. Being more mindful has been theorised to help people to let go of harmful, automatic responses to their experience by creating the space for one to select healthier, more adaptive ways of responding [91].


Some of the main neurocognitive mechanisms implicated in mindfulness meditation include attention control, emotion regulation, and self-awareness [92]. In addition, mindfulness strategies such as mindful attention may have potential mental and physical health benefits, including stress reduction [93], enhanced emotional regulation [94], decreased reactivity and increased response flexibility [95], increased empathy [96], and interpersonal benefits [97]. It seems that mindfulness may serve as a form of mental training to reduce cognitive vulnerability to reactive modes of mind that might otherwise heighten stress and emotional distress.

A recent proposed operational definition of mindfulness consists of a two-component model comprising of :

  1. Self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment, and

  2. Adoption of a particular orientation toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance [98].


The Monitor and Acceptance (MAT) theory suggests that monitoring skills may only be associated with beneficial mental and physical health outcomes when accompanied by acceptance skills [99]. This suggests that bringing an attitude of acceptance toward monitored experiences may be a key emotion regulation mechanism for the effects of mindfulness interventions on affective, stress, social relationship, and health outcomes [100].

We cannot change anything unless we accept it. Condemnation does not liberate; it oppresses- Carl Jung


In regards to disordered eating behaviours, research indicates that non-judgmental awareness may be less important in explaining levels of ED psychopathology than the nature of one’s interaction with emotionally charged, negative experiences [101]. It may be that mindfulness is a necessary initial step for promoting awareness, but it is what you do with that awareness, and how you relate to it, that plays a larger role in determining health outcomes.


Promoting Acceptance

When we avoid our reality, including difficult thoughts and feelings, by chasing short-term relief of discomfort, we usually perpetuate the problem we are facing. This avoidance has been associated with a wide variety of negative outcomes [102], including poorer physical health [103] and lower quality of life [104], and seems to describe a pattern of adjustment seen in those unable to maintain weight loss [105]. Acceptance means opening up to our experience and acknowledging where we are and what we’re struggling with. It involves the active and aware embrace of difficult feelings, thoughts, memories and bodily sensations without unnecessary attempts to change their frequency or form. Etymologically, acceptance comes from the word ‘to take’, meaning to receive or take what is offered. Before we can change, we must ‘take in’ the fact that there is a problem to work on. If we can acknowledge it, we can work on it.

The curious paradox is that when I accept myself as I am, then I can change - Carl Rogers

Acceptance‐based behavioral interventions infuse behavioral treatment with strategically chosen self‐regulation skills that are adapted primarily from ACT [106] and have shown promise in improving weight loss outcomes in those with obesity [107], and reducing cravings [108], particularly in those who are responsive to the presence of food [109].

Practicing acceptance may involve mindfulness techniques such as Urge Surfing, which teaches one to observe and experience their urges or emotions. Learning to focus on the present moment when cravings occur is a technique that can be applied in a wide range of different settings, meaning it’s likely to serve clients well for the long term [110].


Acceptance is also an important component of promoting a positive body image [111]. Body acceptance involves a comfort for the body exactly as it is [112]. It can be developed through the cultivation of a cognitive schema for the body that accepts all shapes, sizes, and unique qualities, in addition to an emotional valence of loving-kindness toward the body. In this way of viewing the body, it is understood that no one can be perfect and that pursuit of illusory media ideals can be physically and mentally harmful. In support of this model, a one day ACT workshop targeting body dissatisfaction and disordered eating attitudes in 73 women with body dissatisfaction was effective in improving eating attitudes, body anxiety, and preoccupation with eating, weight, and shape [113].


Finally, preliminary evidence suggests that women who feel the urgent need to regulate their emotions, and exhibit non-acceptance of distress, may experience a higher drive for muscularity [114], a risk factor for disordered eating pathology [115]. Acceptance is thought to transform how momentary experiences are observed and processed, facilitating engagement (welcoming in) and subsequent disengagement (letting go) with emotional stimuli [116], and thus enriching experience while also reducing emotional reactivity. Women who learn to be more accepting of unpleasant thoughts and emotions regarding their muscularity may not feel urged to employ strategies, such as compulsive exercise, to regulate them. Pilot research suggest that ACT techniques may be effective in addressing distress related to body image concerns [117].



Acceptance isn’t easy and often requires a great degree of courage. People often regard their health difficulties as personal faults or failings, arising from their own inadequacies. Health-related stigma is associated with shame [118], a self-conscious, negative emotion that arises when one is seen or judged by others to be flawed in some crucial way, or when some part of oneself is perceived to be inadequate, inappropriate or immoral [119]. Psychosocial processes associated with experience of low self-esteem and psychophysiological stress resulting from chronic shame, marginalisation and stigma are significant factors in determining health outcomes and wellbeing [120].


Comprehensive Coaches can help to evoke self-acceptance by providing a relationship where clients feel safe and know that they won’t be judged. When safety is expressed, defensiveness is down-regulated. Therapeutic acceptance involves honoring a client’s worth and potential, recognising and supporting their autonomy, seeking through accurate empathy to understand their perspective, and affirming the client’s strengths and efforts. Cultivating presence and engaging in present-centred relationships can facilitate an effective alliance by having both client and coach enter a physiological state that supports feelings of safety, positive therapeutic relationships, and optimal conditions for growth and change [121].


‘If I can provide a certain type of relationship, the other will discover within himself the capacity to use that relationship for growth, and change and personal development will occur’ - Carl Rogers


Facilitating Defusion

Suppose a client is struggling with a negative thought like ‘I will never make progress’, ‘I can’t do this’, or ‘I’m a failure’. They probably will at some point, given that negative thoughts are experienced by 80-99% of the non-clinical population and have been linked to the development of psychopathology [122]. An entanglement between thoughts, feelings, and behaviors, whereby an individual becomes overly identified with distressing thoughts, can lead to behavioural inflexibility. In a state of cognitive fusion, individuals may react to thoughts as though they are literal truths, resulting in difficulty disconnecting from them [123]. This may guide behaviours aimed at alleviating distress, which could be harmful in the long run.


Defusion is an acceptance-based technique which teaches one to see thoughts for what they are - simply thoughts, not literal truths of the world. There are a wide range of defusion techniques [124], but they all serve the same purpose; to help us respond to the thought more flexibly. Defusion has been shown to help non-clinical samples cope with negative self-statements [125], and increase comfort, willingness and positive affect significantly more than cognitive restructuring [126]. Helping clients to detach from negative thoughts may increase behavioural flexibility in pursuit of meaningful goals.

Body image cognitive fusion (BI-CF) describes the extent to which body image-related thoughts are endorsed and drive behaviours and is an important contributor to disordered eating [127]. An individual may experience recurring negative body image-related thoughts that they strongly believe to be true and endorse behaviourally. Negative body image-related thoughts alone may not result in disordered eating, yet research shows that the extent to which body image-related thoughts are endorsed and drive behaviors is an important contributor to ED vulnerability [128]. Individuals may be unaccepting of their body image, but only some may identify with body image-related distressing thoughts to the extent that they would engage in disordered eating behaviors as a result. Individuals experiencing higher BI-CF also experience more disordered eating behaviors and thoughts [129]. It may be prudent to target body image cognitive-fusion in individuals at risk of disordered eating in an attempt to produce psychologically flexible thinking patterns associated with body image [130].


Increasing Self-Compassion

Self-compassion is an alternative way to conceptualize having a healthy stance towards oneself that does not involve evaluations of self-worth [131]; in this way it differs markedly from self-esteem. While self-esteem is contingent on success in valued domains such as appearance or social approval [132], self-compassion involves treating oneself kindly in times of failure. It’s about developing a caring and accepting relationship with yourself, particularly when you face hardships [133]. There are three main components of self-compassion: self-kindness; mindful awareness of negative thoughts and emotions; and a sense of common humanity (recognising that everyone fails, makes mistakes, and gets it wrong sometimes) [134].

‘Every man bares the whole stamp of the human condition’ - Michel de Montaigne

Self-compassion is associated with more stability in state feelings of self-worth than trait self-esteem [135], potentially because self-compassion is less contingent on things like physical attractiveness or successful performances. Additionally, self-compassion is associated with lower levels of social comparison, public self-consciousness, self-rumination, anger, and need for cognitive closure, than self-esteem. This suggests that self-compassionate people are less focused on evaluating themselves, feeling superior to others, worrying about whether or not others are evaluating them, defending their viewpoints, or angrily reacting against those who disagree with them.

A wealth of research has reported consistent associations between self-compassion and lower