Compassion-focused therapy (CFT)

Interventions or therapy which focus on self-compassion is often classified as third-wave cognitive behavioural therapies. The method was first developed to help people with high self-criticism and low self-esteem. But has later been used on several other conditions such behavioural disorders, mental illness or other types of vulnerability.

Question

What systematic reviews are there on the effect of compassion-focused therapy?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
CFT = Compassion-focused therapy; ED = Eating disorder; RCT = Randomized controlled trial; TAU = treatment as usual
Included studies Population/Intervention Outcome
Austin et al, 2021, [1]
Study design: Included controlled trials, observational studies, and qualitative studies.

Included: The review included a total of 20 studies, whereof 6 used CFT. Only one was a controlled study, and the others had a pre-post design.
Population: Patients affected by a long-term physical condition.

Intervention: The main objective of the interventions was the training of (self-) compassion.

Control to CFT (single study):
motivational enhancement therapy.
Psychological outcomes:
All studies (n=12) with a comprehensive intervention found a significant effect for reduced anxiety and depression.

Physical outcomes:
2 of 4 studies with a comprehensive intervention found a significant pre-post effect on pain.

Health-related quality of life
Four of five studies with comprehensive interventions found a significant pre-post effect on health-related quality of life.
Author’s conclusion:
“In conclusion, compassion-based interventions represent a potentially beneficial way to support people with long-term physical conditions and are well-received by intervention participants. Nonetheless, it is clear that the field and the available evidence are in their infancy. First indications of intervention effectiveness are improvements in anxiety, depression, self-compassion and health-related quality of life, among other outcomes.”
Craig et al, 2020, [2]
Study design: Included randomized controlled trials, controlled trials and observational studies.

Included: n=29, whereof 9 studies were RCTs and 3 controlled trials.
Population: Clinical populations, defined as individuals experiencing symptoms of any mental health condition, including depression, psychosis, post-traumatic stress, eating disorders, etc.

Intervention: Included only CFT, as defined by those delivering the intervention and deemed to have covered core components (such as psychoeducation on tricky brain and three emotion regulation systems, and practices including soothing rhythm breathing and compassionate imagery).

Control: Most studies used TAU or a waitlist control. 5 of 29 studies compared CFT to an alternative treatment, for example mindfulness, group relaxation and psychoeducation.
All but one of the RCTs found a significant change in primary outcomes according to the authors.
The following list of outcomes is not complete since results only were presented narratively and the information often was lacking in the review. For more information of outcomes and results, see the included studies.

Outcomes for mental health disorders:
Three studies included patients with mental health difficulties (borderline, psychosis and mixed). All three found a significant clinical effect on several outcomes.

Outcomes for eating disorder: Four studies included patients with an eating disorder (Anorexia, binge eating, mixed). Three of four studies found a positive effect on ED-related outcomes.
Authors' conclusion:
“This review found that CFT is likely to be more effective than no treatment in clinical populations and suggests that group CFT might be more effective than other psychological interventions. It shows promise in conditions with underlying shame and self-criticism, with encouraging results across severe and complex mental health problems. It is possible that brief CFT may reduce mental health symptoms and increase self-compassion, however, there is some evidence that at least 12 h is required for significant and longer-lasting change.”
Wakelin et al, 2021, [3]
Study design: Randomized controlled trials.

Included: n=20. Whereof 7 were based on a clinical population.
Population: Includes all populations, both clinical and non-clinical. Demanded a quantitative measure of self-criticism.

Intervention: Includes any intervention describing content and techniques that cultivate a sense of self-compassion.

Control in clinical populations:
Guided imaging, support group, behavioural strategy training, mindfulness training, waitlist or TAU.
Self-criticism based on Hated-self (FSCRS-HS) or inadequate-self (FSCRS-IS) measures.

Self-criticism (Hedges’g)
A significant, medium size reduction in self-criticism
0.51 (95% CI, 0.33 to 0.69)

Subgroup analysis:
Clinical (n=7)
0.38 (95% CI, 0.11 to 0.65)
Non-clinical (n=13)
0.57 (95% CI, 0.34 to 0.79)
Authors' conclusion:
“The meta-analysis indicated that self-compassion-related interventions produce a significant, medium reduction in self-criticism in comparison with control groups. This replicates Ferrari et al.'s (2019) meta-analysis findings in a larger sample of RCTs, suggesting the finding is reliable. Furthermore, greater reductions in self-criticism were seen when self-compassion-related interventions were longer in duration of days and compared with passive controls rather than active”

References

  1. Austin J, Drossaert CHC, Schroevers MJ, Sanderman R, Kirby JN, Bohlmeijer ET. Compassion-based interventions for people with long-term physical conditions: a mixed methods systematic review. Psychol Health 2021;36:16-42.
  2. Craig C, Hiskey S, Spector A. Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev Neurother 2020;20:385-400.
  3. Wakelin KE, Perman G, Simonds LM. Effectiveness of self-compassion-related interventions for reducing self-criticism: A systematic review and meta-analysis. Clin Psychol Psychother 2021.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 6/23/2021
Report no: ut202113
Registration no: SBU 2021/254