Validation of the Body Compassion Scale in multiple sclerosis.

This study’s cross-sectional design and its analyses were pre-registered at OSF. In accordance with the Journal Article Reporting Standards (Kazak, 2018), we report our data collection method, measures, and all data exclusions. The materials and analysis code are available at https://osf.io/x7mfu . Data were analyzed using Mplus , Version 8 ( Muthén & Muthén, 1998 ) and SPSS Version 28 ( IBM Corp, 2021 ). This study is a secondary analysis of this dataset. Potential participants with MS were invited to complete an online survey via recruitment emails sent to the University of Washington research participant registry (which has approximately 1,900 adults with MS interested in MS research from across the U.S.. The National MS Society also sent the survey link through a national email announcing various research opportunities to people with MS. The recruitment email described the study’s purpose, which was to assess stress, coping, resilience, mental health, and common co-occurring symptoms, including pain, sleep disturbance, and fatigue. To be included, individuals needed to be ≥18 years old, able to read English to complete the survey, and self-report having an MS diagnosis. Participants completed the survey online between August 2023 and February 2024 via the REDCap (Research Electronic Data Capture) web-based data capture platform accessible by any digital device with internet access ( Harris et al., 2009 ). REDCap includes a human verification service (reCAPTCHA) to avoid responses from non-human/artificial respondents. Respondents with incomplete surveys were contacted once by a follow up email requesting that they complete the survey using a unique survey link. Participants were not compensated for completing the survey. The University of Washington Human Subjects Division approved the survey procedures. Informed consent was obtained from participants via an information statement (consent form) which described the study procedures, rights as participants, and notifying them that completing the survey indicated their consent to participate. After consenting to participate, 1,218 participants completed screening questions about their MS diagnosis, which included two attention questions to assess for inattentive responding. Inattentive responding was defined as missing both attention checks. Three hundred and sixty people did not pass the attention checks, five additional individuals were excluded due to outlier values on age, and 24 duplicate cases were removed. We removed duplicate cases because: 1) two or more incomplete data entries came from the same person, in which case, we removed the cases with the least complete data (n = 2); 2) two or more complete cases came from the same person, in which case, we removed the cases that were entered after the first case (n = 5); or 3) entries with the same demographic data, but psychosocial data that appeared to come from two different people, and for these, we removed both cases to avoid confusion (n = 17). Individuals who were missing all body compassion items were also not included (n = 152). Subsequently, 677 people were included in factor analyses. See Table 1 for participant characteristics. Body compassion was assessed using the 23-item Body Compassion Scale (BCS; Altman et al., 2020 ), which is composed of three subscales – defusion, common humanity, and acceptance – plus a total score. Answers range from 1 (almost never) to 5 (almost always) with higher scores indicating greater body compassion. Items include both positively (“I feel okay in my body”) and negatively (“When I am feeling physically uncomfortable, I tend to obsess and fixate on everything that’s wrong”) valenced items. A total score was calculated by reverse-scoring the defusion items and then summing all items together (range 23 to 115). Subscale scores were computed by reversing nine items and taking the mean of the items in each subscale (range 1 to 5). Higher scores indicate greater compassion for one’s body. Internal consistency in the current sample was α = .92, indicating excellent reliability. Fatigue was measured using the 8-item PROMIS Fatigue Scale, which has been validated in MS samples ( Cook et al., 2012 ). Participants rated the extent to which symptoms of fatigue impact their lives. Answers range from 1 (never) to 5 (always) with higher scores indicating greater fatigue. Example items include questions such as, “How often did you feel tired even when you hadnť done anything?” and “How often were you too tired to think clearly?”. A total score was calculated by summing all items together (range 8 to 40). Higher scores indicate more fatigue. Internal consistency in the current sample was α = .95. Perceptions of cognitive functioning were assessed using the 4-item PROMIS Cognitive Functioning Scale ( Becker et al., 2014 ). Answers range from 1 (very often; several times per day) to 5 (never). Example items include, “I have had trouble shifting back and forth between different activities that require thinking” and “It has seemed like my brain was not working as well as usual”. Total scores were computed by summing all items together (range 4 to 20). Higher scores indicate more favorable perceptions of cognitive functioning. Internal consistency in the current sample was α = .95. The PROMIS Cognitive Functioning scale has been validated in MS samples ( Becker et al., 2014 ). Disability and walking ability were assessed using the Patient Determined Disease Steps (PDSS; Learmonth et al., 2013 ). The PDSS is a self-report questionnaire of disability in MS and consists of a single item with nine categories ranging from 0 (normal functioning) to 8 (unable to sit in a wheelchair for > 1 hour). Higher scores indicate more severe disability. Two scales captured participant’s experience of pain. Pain intensity was measured using a single item visual analog scale asking patients to rate their average pain over the past week from 0 (no pain) to 10 (maximum pain). Pain interference was measured using the 4-item PROMIS Pain Interference Scale, validated for MS samples ( Amtmann et al., 2010 ). Participants are asked to respond to the extent to which pain interferes with daily activities, chores, social activities, and work. Items are rated on a scale from 1 (not at all) to 5 (very much). Total scores for the pain interference scale were computed by summing all items together (range 4 to 20). Higher scores indicate more pain interference. Internal consistency for pain interference in the current sample was α = .97. Resilience was measured using the Connor Davidson Resilience Scale (CDRISC; Connor & Davidson, 2003 ). The CDRISC consists of 10-items asking participants to indicate how statements of resilience apply to them over the past month. Items are rated on a scale from 0 (not at all true) to 4 (true nearly all the time). The CDRISC has been validated in MS samples ( Broche-Pérez et al., 2022 ). Example items include, “I try to see the humorous side of things when I am faced with problems” and “I believe I can achieve my goals, even if there are obstacles”. Total scores were computed by summing all items together (range 0 to 40). Higher scores indicate greater resilience. Internal consistency in the current sample was α = .90. Anxiety was measured using the Generalized Anxiety Disorder - 7 (GAD-7; Spitzer et al., 2006 ) and has been validated in MS samples ( Terrill et al., 2015 ). Participants rate the frequency with which they experience various anxiety symptoms. Items are rated from 0 (not at all) to 3 (nearly every day). Total scores were computed by summing all items together (range 0 to 21). Higher scores indicate the presence of more severe anxiety symptoms. Internal consistency in the current sample was α = .92. Depressive symptom severity was measured using the Patient Health Questionnaire - 8 (PHQ-8; Kroenke et al., 2010 ) and has been validated in MS samples ( Patrick & Connick, 2019 ).Participants rate the frequency with which they experience various depressive symptoms. Items are rated from 0 (not at all) to 3 (nearly every day). Total scores were computed by summing all items (range 0 to 24). Higher scores indicate the presence of more severe depressive symptoms. Internal consistency in the current sample was α = .86. Demographic factors were also collected. These included age, sex, gender identity, sexual orientation, race/ethnicity, employment status, years of education, and MS disease course. Sex, gender identity, sexual orientation, race/ethnicity, employment status, years of education, and MS disease course were assessed via multiple choice and response options are listed in Table 1 . All analyses were conducted in Mplus Version 8 ( Muthén & Muthén, 1998 ). To account for potential heterogeneity in factor structure of the BCS in people with MS compared to the population it was normed on, we first completed exploratory factor analysis (EFA) with a random half of the sample (n = 332) to examine the underlying factor structure among this population. We conducted the EFA using robust maximum likelihood (ML) factor analysis and oblique geomin rotation to allow for correlation among factors. Examination of the scree plot and parallel analysis were used to determine the number of factors to be tested using EMA, consistent with best practice. Item content was also used to help determine the final recommended factor solution. Confirmatory factor analysis (CFA) was conducted using the other random half of the sample (n = 345) to evaluate model fit statistics [root mean square of approximation (RMSA) 0.95, and standardized root mean square residual (SRMR) < 0.08; Hu & Bentler, 1999 ] of the factor solution suggested by the EFA. Robust ML was also used for the CFA. A post hoc power analysis using the semPower package in R indicated that the CFA model with 74 degrees of freedom and sample size of 345 yielded power greater than 99%. This high power indicates strong sensitivity to detect effects. Pearson correlations were performed to examine correlations between the BCS and MS symptoms and psychological factors. Pearson correlations, independent samples t-tests, and one-way analysis of variance (ANOVAs) were performed to explore comparisons of the BCS within demographic factors.

Descriptive statistics for individual items of the BCS are shown in Supplementary Material . Intra-item correlations reflected the original separation of the BCS into defusion, common humanity, and acceptance subscales. Table 1 describes the demographic characteristics of the participants. The scree plot for the BCS items suggested evaluation of one-, two-, three-, and four -factor models (see Supplementary Material ). The first four sample eigenvalues were 8.75, 4.74, 2.34, and 1.00. Comparison of parallel analysis and the scree plot suggested that we evaluate a one-, two-, and three-factor solution (see Supplementary Material ). The first three eigenvalues from the parallel analysis were 1.51, 1.42, and 1.36. According to Horn (1965) , factors are considered significant if the associated eigenvalue is bigger than that derived from the random data. Thus, one-, two-, and three-factor solutions were evaluated. Items loading onto the first, second, and third factor aligned with prior psychometric evaluations of the BCS. Therefore, we considered the three-factor solution to be the most promising. Within the three-factor solution, the first factor (defusion) consisted of 9 items, with loadings ranging from 0.61 to 0.88. Factor 2 (common humanity) consisted of 8 unique items. Item loadings ranged from 0.60 to 0.89. Factor 3 (acceptance) consisted of 5 items, with loadings ranging from 0.79 to 0.92 (see Table 2 for EFA factor loadings). Defusion was not significantly correlated with common humanity, r = −0.221, but was significantly correlated with acceptance, r = −0.508. The correlation between common humanity and acceptance was significant, r = 0.230. Scale scores for the subscales were calculated by summing the relevant items identified in the EFA. The defusion subscale had internal reliability of 0.94. The common humanity subscale had internal reliability of 0.93. The acceptance subscale had internal reliability of 0.94. The three-factor model solution from the EFA was then tested in a CFA. Nine items (1, 2, 3, 4, 5, 6, 7, 8, and 9) assessed the construct of defusion. Eight items (10, 11, 12, 13, 14, 15, 16, 17, and 18) assessed the construct of common humanity. Five items (19, 20, 21, 22, 23) assessed the construct of acceptance. The three-factor model had less than adequate fit to the data according to the RMSEA and SRMR fit indices (CFI = 0.877, RMSEA = 0.100, SRMR = 0.072). Modification indices suggested that there remained residual covariance among subsets of the items. Two residuals were added (Item pairs 1 / 2, and 11 / 12) and the resulting model fit better (CFI = 0.914, RMSEA = 0.084, SRMR = 0.068; see Figure 1 ) with minimal impact on the factor loadings (loadings with and without the modification indices were correlated over 0.95). Defusion was not significantly correlated with common humanity ( r = −0.037) but was negatively correlated with acceptance ( r = −0.438, p < .001). Common humanity was significantly correlated with acceptance ( r = 0.203, p < .001). Table 3 depicts the associations of the BCS with MS symptoms and psychosocial measures. Pearson correlations showed that fatigue was negatively correlated with total BCS score, defusion, and acceptance such that higher fatigue was related to less BCS total, defusion, and acceptance scores. Cognitive functioning was positively correlated with total BCS score, defusion, and acceptance such that higher cognitive functioning was related to higher BCS total, defusion, and acceptance scores. Mobility disability was negatively correlated with total BCS score and defusion such that greater mobility disability was associated with less BCS total and defusion scores. Pain severity was negatively correlated with total BCS score, defusion, and acceptance such that greater pain severity was related to less BCS total, defusion, and acceptance scores. Pain interference was negatively correlated with total BCS scores, defusion, and acceptance such that greater pain interference was related to less BCS total, defusion, and acceptance scores. Common humanity was not significantly correlated with any MS symptom measure. Pearson correlations showed that resilience was positively correlated with total BCS score, defusion, common humanity, and acceptance such that greater trait resilience was related to greater BCS total and subscale scores. Anxiety symptoms were negatively correlated with total BCS score, defusion, and acceptance such that greater anxiety symptom severity was related to less BCS total and subscale scores. Depressive symptoms were negatively correlated with total BCS score, defusion, common humanity, and acceptance such that greater depressive symptom severity was related to less BCS total and subscale scores. Pearson correlations showed that age was positively correlated with total BCS score ( r = .14, p < .01) indicating individuals who were older tended to have a higher BCS total score as well as higher defusion ( r = .20, p < .01) and acceptance ( r = .08, p < .05) scores. There was no association between age and the common humanity subscale score. Independent samples t-tests showed no significant differences in total BCS scores between biological male and female participants nor between those that identified as men or women. However, females scored significantly higher on the common humanity subscale, t (670) = −2.94, p < .01, but significantly lower on the acceptance subscale, t (668) = 4.73, p < .001 compared to males. Cohen’s d was calculated to assess the standard mean difference between females and males on common humanity and acceptance. The effect sizes were large (Cohen’s d = .95 and 1.12), indicating meaningful differences between the two groups. One-way ANOVA was performed comparing the BCS among the different gender identity categories. People identifying as women reported significantly lower acceptance scores compared to those that identify as men, F (2, 666) = 9.80, p < .01, but the effect size for this difference was small (η 2 = .029) and likely attributed to the diversity of gender identity categories compared to biological sex categories. One-way ANOVA found that BCS total score, defusion, and common humanity differed significantly among people of different educational backgrounds. We found a linear trend such that the more education people had, the higher BCS total and subscale scores. Specifically, individuals with a high school education or less had lower scores on total BCS, defusion, and common humanity compared to people who completed some college or those with a college degree. Similarly, individuals who had some college education showed lower scores on the total BCS, defusion, and common humanity compared to people who had a college degree (all p s < .01). The effect sizes for these differences were small (η 2 = .019 to .029). Independent samples t-tests were performed comparing the BCS among different MS disease courses. There were significant differences between individuals with relapsing remitting vs. progressive forms of MS (i.e., secondary progressive, primary progressive, progressive relapsing). Specifically, individuals with progressive forms of MS had lower total BCS, t (632) = 3.35, p < .001 and defusion scores, t (632) = 3.80, p < .001, compared to people with relapsing remitting MS (RRMS). There were medium to large effect sizes (Cohen’s d = .76 and 1.09), indicating meaningful differences between the two groups. There were no significant differences in BCS total score or subscale scores between race/ethnicity groups and individuals who were employed versus unemployed, or between individuals of different sexual orientations.

This study examined the factor structure, content validity, convergent validity, and relevant associations of the BCS among people with MS and results suggest the three-factor structure identified in the original validation study, conducted in a college-aged sample, is applicable in a sample of adults with a chronic neurodegenerative condition. Three other studies have used the BCS to measure body compassion in women’s health conditions, including perimenopause, polycystic ovary syndrome, and endometriosis ( Altman, 2018 ; Van Niekerk et al., 2022 , 2023 ). To date no studies have assessed the psychometric properties in a sample of people with a chronic condition or disability. The results of this study support defusion , common humanity , and acceptance as strong factors and thereby, support use of the BCS in research, clinical assessment, and interventions regarding the role of body compassion in rehabilitation and chronic condition populations, specifically MS. The three-factor structure of the BCS was previously identified and validated in undergraduate samples ( Altman et al., 2020 ) and a sample of women in perimenopause ( J. Altman, 2018 ). The current study confirmed the three-factor structure of the BCS in a sample of adults with MS. The BCS showed excellent construct validity, with the CFA demonstrating good model fit. In addition, the BCS and its factors of defusion, common humanity, and acceptance exhibited excellent validity with measures of MS symptoms expected to have associations with body compassion (see Table 3 ). One notable exception was the common humanity factor of the BCS, which was not significantly correlated with any MS symptom measure. This finding coincides with previous research in women in perimenopause that found negative correlations of defusion and acceptance with appearance orientation (i.e., greater degree of investment in one’s physical appearance), but did not find a statistically significant correlation between common humanity and appearance orientation. The study author suggested that common humanity items could inadvertently be “a tool of social comparison rather than a reminder of interconnectedness when it comes to body image-based difficulties” ( Altman, 2018 , p. 82). As reflected in the common humanity subscale items (e.g., When I am at my lowest during times of physical symptoms, illness or injury, I know I am not alone in feeling this way ), this finding may be reflective of difficulty identifying with a shared humanity when one’s personal experience feels different from that of others. Body compassion was associated with all MS symptoms measured in this study. Total BCS scores showed moderate negative associations with fatigue, mobility disability, pain severity, and pain interference and small positive associations with perceived cognitive functioning. These findings are consistent with previous literature in adults with chronic conditions. In a study of endometrial cancer patients, the BCS was negatively significantly associated with pain severity and pain interference ( Denu, 2018 ). Similarly, a study examining BCS scores in people with endometriosis found that the BCS was negatively correlated with pain, physical role limitations, and fatigue ( Van Niekerk et al., 2023 ). These results are also consistent with previous investigations of self-compassion in people with MS and the correlation of fatigue with self-compassion ( Giménez-Llort et al., 2021 ). Future experimental or longitudinal work is warranted to determine whether changes in the BCS are sensitive to changes in MS symptoms. Additionally, future studies may assess the utility of the BCS versus a more global measure of self-compassion like the Self-Compassion Scale (SCS) in people with chronic health conditions like MS. Body compassion was associated with resilience, anxiety, and depressive symptoms in this sample of people with MS. The positive correlation of the total BCS score with resilience supports the convergent validity of the BCS for people with MS. Likewise, the negative correlations between the total BCS score and anxiety and depressive symptoms are in the expected direction. These findings are consistent with existing literature involving individuals with chronic conditions. In a study examining the BCS in people with endometrial cancer, higher body compassion (total BCS) was associated with lower negative affect and higher quality of life ( Denu, 2018 ). Another study examining the BCS in women with perimenopause found that the BCS total score was positively associated with positive affect, and negatively associated with depression and negative affect ( Altman, 2018 ). Finally, a study examining the BCS in women with polycystic ovary syndrome found that the BCS was negatively associated with emotional distress ( Van Niekerk et al., 2022 ). These results are also consistent with previous investigations of self-compassion in people with MS and the correlation of depression, anxiety, resilience with self-compassion ( Gedik & Idiman, Egemen, 2020 ; Nery-Hurwit et al., 2018 ). Future research is needed to clarify causal influence in these relationships to clarify if and how increasing body compassion could improve psychosocial health in rehabilitation populations. The associations identified in the present study and in previous literature, of body compassion with symptoms of MS and the potential emotional sequalae of living with a chronic neurodegenerative condition, suggest that body compassion may be a potential target or vehicle for improving overall quality of life via symptom reduction and improved psychological well-being. For example, an individual living with MS and with low overall levels of body compassion may be “fused” with physical symptoms as definitive of who they are (low defusion , example item, When I’m feeling physically uncomfortable I tend to obsess and fixate on everything that’s wrong .). They may feel isolated when faced with physical symptoms (low common humanity , example item, When I feel frustrated with my body’s inability to do something, I try to remind myself that most people in my condition feel this way at some point.) . Finally, they may have considerable resistance related to their body’s expression of symptoms (low acceptance , example item, I feel okay in my body ). Viewed through the factor structure of the BCS, an individual can increase the level of compassion they have for their body as they broaden and expand their view of self beyond the body and physical symptoms ( defusion ), recognize that others also face physical challenges ( common humanity ), and acknowledge the physical reality of the body in the moment ( acceptance ). Future research should examine if and how body compassion might improve as a result of psychological or rehabilitation (e.g., exercise interventions. Levels of body compassion differed across certain demographic and clinical factors in this sample of people with MS. Participants with progressive MS reported lower total BCS and defusion scores than individuals with RRMS (medium-large effect sizes; Cohen’s d = .76 and 1.09, respectively). People with progressive MS have greater cognitive and physical disability compared to those with RRMS ( Gross & Watson, 2017 ; Lugosi et al., 2024 ), and greater disability was negatively correlated with body compassion in this sample. Thus, it is possible that adults with greater disease severity, as measured by mobility disability, have lower body compassion compared to adults with lower disease severity. Future research should clarify the relationship between disease severity and body compassion in people with MS, as body compassion is a potentially modifiable psychosocial construct and target for improving coping with the emotional and physical sequelae of disability. In addition, females scored higher on the common humanity subscale, but lower on the acceptance subscale, compared to males (large effect sizes, Cohen’s d = .95 and 1.12). Although defusion, common humanity, and acceptance are factors of body compassion, individuals and groups may report higher levels of one factor versus another. The current finding suggests that compared to males, females with MS report greater recognition of the collective experience of living in an imperfect physical body but lower acceptance of their own body’s current appearance, state of health, and functioning. Results are similar to those of previous studies. For example, among people with irritable bowel disease (IBD), women appear to have greater fusion to thoughts around body image ( Trindade et al., 2019 ) and generally women report greater body image dissatisfaction compared to men ( Jones & Buckingham, 2005 ). In another sample of college students without chronic conditions, women endorsed higher scores on common humanity compared to men ( Murn & Steele, 2020 ). Gender role expectations may help to explain these findings. For instance, men may identify more strongly with body challenges as a personal fault, rather than a collective experience. Women may have more difficulty accepting their bodies due to societal pressures to conform to certain standards. It is important to clarify this potential imbalance in body compassion factors in females versus males as it could inform differential development of strategies to increase body compassion. Notably, total BCS scores were positively correlated with age, self-reported disability, and level of education though the effect sizes were small (η 2 = .019 and .029). Replication studies are needed to confirm whether body compassion differs based on older age, disability, and higher education level in other MS samples. Regarding disability, one study reported that people with MS who reported higher levels of disability [as measured by the Expanded Disability Status Scale (EDSS)] reported higher scores on the self-kindness dimension of the SCS compared with people who had lower levels of disability ( Ignatova et al., 2016 ). Regarding education level, relatively few studies have explored differences in compassion based on education level. One study found that while individuals with fewer years of education had greater compassion for others compared to people with more years of education, they tended to have less self-compassion ( López et al., 2018 ). A possible rationale could be lack of familiarity with the concept of having compassion for oneself. Other factors, such as socioeconomic status, may compound these differences. For example, compassion for oneself may be irrelevant if there is a focus on meeting basic needs. Although preliminary, these findings suggest that there may be additional value in assessing body compassion in people with MS. While people with MS may relate to their larger sense of self with kindness during times of suffering, they may still feel consumed and callous towards their body when the body experiences challenges. Finally, in this sample, there was no evidence that BCS scores differed by race, ethnicity, sexual orientation, or employment status. We postulate that this was due to the limited diversity in our sample in terms of race, ethnicity, sexual orientation, and employment status, which reduced our power to detect significant associations. For example, employment status was examined as a binary variable, so future research could examine employment status with more granularity to probe for differences. We stress, however, that failure to detect an association does not mean that there is not an association, and we recommend examining the BCS in a more diverse sample. In this cross-validation study of the BCS in people with MS, the factor structure identified in initial development studies was confirmed in a large sample of 677 individuals. Another important methodological strength of this study is the conservative approach used in first completing an EFA to examine the underlying factor structure of the BCS among people with MS given the potential heterogeneity compared to the population on which it was first normed. Though more investigation is needed, the results of this study suggest potential application of body compassion in targeted measurement and treatment pertaining to the body and how an individual relates to their physical experience while living with a chronic condition. Another significant strength of this study is its focus on people living with MS, who can experience myriad symptoms, including physical symptoms of fatigue, cognitive problems, mobility disability, and pain and psychological symptoms of anxiety and depression. Given the risk of disease relapse and uncertainty around symptom occurrence, people living with MS offer a unique perspective on the relevance of body compassion for improving behavioral interventions aimed at increasing mental and physical health and quality of life in people living with chronic conditions or disability. A final strength is the use of validated self-report measures in MS samples. The SCS and Multidimensional Body Self Relations Questionnaire (MBSRQ) were not included in this study, which precluded the ability to compare the BCS to the SCS and MBSRQ to determine the incremental validity of body compassion, and its measurement with the BCS, above and beyond established gold standard measures of self-compassion and body image. Further research to address this limitation is warranted. Another limitation is that the results may not generalize to other rehabilitation populations. Future work may involve validating the BCS for individuals with spinal cord injury, traumatic brain injury, stroke, amputation, and long COVID. Finally, the use of self-report measures is an additional limitation. Future studies might consider validating the BCS against objective measures of MS symptoms, such as neurocognitive assessments. Body compassion describes the quality of relationship one has with their body, a particularly salient relationship for individuals navigating the fluctuating symptom experience of living with MS. To date there is a growing body of evidence utilizing the BCS with various populations, including in people with polycystic ovarian syndrome, endometriosis, cancer, and disordered eating behaviors. Given the confirmation of the three-factor structure in the original development studies with an undergraduate sample, a sample of women in perimenopause, a community sample of females, and now in a sample of people with MS, the BCS may be considered a robust measure of body compassion across samples and symptom presentations. Nonetheless, extending these findings to other rehabilitation populations such as spinal cord injury or traumatic brain injury may be a fruitful next step in understanding body compassion in those with acquired disabilities. Moving forward, it will also be important to assess the role of body compassion in outcomes of behavioral intervention trials in rehabilitation populations. To date, most studies examining compassion focused treatments and body image have utilized self-compassion groups, meditations, and writing/diary exercises, as well as compassion-focused therapy, and have shown improvements in body image constructs such as body dissatisfaction, body appreciation, and eating disordered behaviors ( Braun et al., 2016 ), including in breast cancer survivors ( Mifsud et al., 2021 ). However, only one published case study has utilized an intervention specific to the construct of body compassion and utilized specific exercises targeting body compassion via its components of defusion , common humanity , and acceptance , via tools such as a functional analysis, body thoughts log, compassionate body scan, and a body compassion letter ( Altman et al., 2017 ). If body compassion is found to influence treatment outcomes, behavioral treatments may be improved by including strategies designed to increase body compassion as an indirect (or direct) route to improving symptoms, psychological functioning, and quality of life. The present study provides support for continued use and application of the BCS as a reliable and valid measure of body compassion among people living with chronic conditions, specifically people with MS. The salience of the body in the experience of living with a chronic condition, supports the relevance of fostering the relationship an individual has with their body as they navigate the ever-changing landscape of their physical experience via varying and unpredictable symptom expression. Further study of body compassion in people with chronic conditions like MS presents a potential opportunity to promote a compassionate stance in the relationship with one’s body that may have beneficial effects on mental and physical health and quality of life. Elucidation of the influence, if any, of increasing body compassion on treatment outcomes such as fatigue, pain, and mood may provide a novel avenue to alleviate the impact of symptoms and improve health behaviors, wellbeing, and QoL in people living with chronic neurodegenerative conditions.