The benefits of cultivating compassion have been described for thousands of years and, over the last two decades, an increasing number of therapeutic approaches have been promoting its use in addressing mental health difficulties. As an evolutionary-focused, biopsychosocial therapy model, Compassion Focused Therapy (CFT) conceptualizes compassion as a prosocial motivation, characterized by “the sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it”. CFT’s primary goal is to help individuals nurture compassion in three key directions: from others, towards others, and towards themselves. This approach proves particularly helpful in addressing issues like self-criticism and shame. Remarkably, CFT has found application in treating various mental health difficulties, including depression, bipolar disorder, anxiety, and obsessive-compulsive disorder. But it doesn’t stop there; CFT has also ventured beyond clinical settings to promote mental well-being in the general public.
In this series of meta-analyses we set out to examine the efficacy of Compassion Focused interventions compared to control conditions in impacting:
- Overall negative mental health outcomes (Meta-Analysis 1), and in particular
- depression (Meta-Analysis 2)
- and self-criticism (Meta-Analysis 3)
- Overall positive mental health outcomes (compassion for self and others), in clinical and non- clinical populations (Meta-Analysis 4)
We also attempted to identify what might influence how effective compassion-focused interventions are for different outcomes, thus we examined many moderators such as country of origin, type, format and setting of CFT intervention, and number of facilitators.
Systematic searches originally yielded a total of 1,157 results, but we ended up performing the meta-analyses on a total of 47 randomized controlled trials. We only included papers with interventions that explicitly referred to Gilbert’s model of compassion as an evolved social motive, while we only considered cases of combined or integrated treatments if it was possible to disentangle the unique contribution of CFT.
The results we obtained highlighted that CFT appears to be particularly effective in reducing overall symptoms of depression and anxiety, with a large effect size compared to other examined mental health difficulties; we imagine this could be linked to the fact that CFT procedures and techniques were originally designed to work with depressed patients with high shame and self-criticism and that there is a high comorbidity between depression and anxiety. CFT was superior to control conditions with a medium effect size (g = .49) on depressive symptoms.
As regards to the impacts of CFT on self-criticism, we found that CFT was superior to control conditions, with a medium effect size (g= .40). We also found that CFT was superior to control conditions in improving compassion both for self and others, with an effect size that remained medium even after the exclusion of three extreme outliers (g = .51).
Interestingly, CFT appeared to be equally effective in reducing overall mental health symptoms in both clinical and non-clinical samples, whether delivered alone or in combination with other interventions, in group or individual formats. Moderation analyses also showed that a significantly larger effect size was reported when CFT was delivered by a therapist compared to when it was delivered as a self-help or “mixed” intervention. On the other hand, the setting of the interaction (whether online, face-to-face, or mixed) did not have a significant impact on the efficacy of the intervention – this implies that CFT is equally effective in reducing overall mental health issues both when delivered face to face and online.
Our study expanded on previous meta-analyses of CFT and provided valuable insights into the efficacy of CFT in numerous clinical and non-clinical populations. That beings said, we recognize there were some limitations to our work, notably the high heterogeneity across the studies for the four outcomes measured, as well as the small sample sizes of some of the RCTs.
We believe that our findings shed light on the need for further studies to improve our general understanding of the efficacy of CFT interventions; in particular, we suggest that larger and more adequately powered RCTs be conducted, possibly with an active comparison, and for these to present greater transparency in their applied methodologies. Furthermore, we believe that measures should be selected carefully to reduce heterogeneity of findings.
Petrocchi, N., Ottaviani, C., Cheli, S., Matos, M., Baldi, B., Basran, J. K., & Gilbert, P. (2023). The impact of compassion-focused therapy on positive and negative mental health outcomes: Results of a series of meta-analyses. Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000193
- Which mental disorders are most greatly impacted by shame and self-criticism?
- How can we improve the effects of CFT in reducing symptoms that are not strictly related to shame and self-criticism?
- What are some of the challenges for therapists in incorporating compassion in their interventions?
- What ensures long-term effects for compassion-focused clinical interventions?
About the Authors
Nicola Petrocchi, PhD, is a psychotherapist and teaches Health Psychology and Psychopathology at the John Cabot University in Rome. They are international CFT trainer and supervisor, founder and president of Compassionate Mind Italy and today conducts CFT workshops in Italy and Europe and the USA. Their research topic focuses on the physiological correlates of prosocial motivations, and the activation of compassion towards ourselves and others to overcome pathological self-criticism and improve psychophysiological wellbeing.
Cristina Ottaviani, PhD, PsyD, is a clinical psychophysiologist and is currently an Associate Professor at the Department of Psychology, Sapienza University of Rome, Italy. In the field of Compassion Focused Therapy, she has authored a series of experimental and meta-analytic investigations on the psychophysiological signatures of compassion, with a particular focus on vagal function.
Simone Cheli, PhD, PsyD, is lecturer at the Rome campus of St. John’s University and director of Tages Charity, a center devoted to mental health research and interventions that is located in Florence. His main area of interest is treatment of personality pathology with a special focus on the integration of evolutionary psychopathology, compassion focused therapy and metacognitively oriented therapies.
Marcela Matos, PhD, PsyD, is a Clinical Psychologist and Auxiliary Researcher at the University of Coimbra’s Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Portugal. With a 15-year focus, her work explores evolutionary clinical psychology, compassion focused interventions, contextual behavioral approaches and contemplative methods. She has extensively studied compassion, shame and traumatic memories, delving into their impact on mental health and personal identity. Currently, her research centers on compassion-focused group interventions, investigating their effects on well-being, epigenetics, and stress responses. Dr. Matos has authored +80 international articles, covering compassion, emotional regulation, shame, psychopathology and wellbeing, and actively contributes to compassion-focused organizations globally.
Beatrice Baldi, PsyD, is a PhD scholar at the Department of Psychology, Sapienza University of Rome, Italy, clinical psychologist, CFT trainer and 500H-certified Yoga instructor certified in Trauma-Sensitive Mindfulness. She has been collaborating for several years with Dr. Nicola Petrocchi in spreading a Compassion-focused approach to working with the body.
Jaskaran K. Basran, PhD scholar within the Centre for Compassion Research and Training (Psychology) department at the University of Derby. Alongside this, she is Foundation Manager and Research Coordinator at the Compassionate Mind Foundation and part of the international research team. Her main interest is compassion, narcissism and developing prosocial motivation in the context of business and leadership. Her current work is based upon developing compassion focused interventions for narcissism and she has been involved in and published a variety of process and intervention studies focusing on mental health and compassion.
Paul Gilbert, FBPsS, PhD, OBE is Professor of Clinical Psychology at the University of Derby and has an honorary visiting professorship at the University of Queensland. He has researched evolutionary approaches to psychopathology with a special focus on mood, shame and self-criticism in various mental health difficulties for over 40 years, and is the pioneer of Compassion Focused Therapy. In 2006 he established the Compassionate Mind Foundation as an international charity which aims to promote wellbeing through the scientific understanding and application of compassion (www.compassionatemind.co.uk). He is the author and editor of 23 books and many other publications.
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