5 Evidence-Based Benefits to Mental Health of Compassion Focused Therapy
I talk a lot about compassion! But isn’t it just a nice idea? Something warm and fuzzy, but not very practical? No! Compassion is really, really helpful, in lots of very practical ways, and there is plenty of scientific evidence that supports this claim.
In fact, learning how to cultivate compassion through an approach like compassion focused therapy can have profoundly positive effects on mental health. So, in today’s video I’m going to give you 5 evidence-based benefits of compassion focused therapy! There are others!! But let’s start with five.
Before we get started, let me do a brief preamble of terms and so on.
Compassion is a sensitivity to suffering in self and others, with a commitment to try to alleviate and prevent it.
Compassion is considered to flow in three directions: compassion for others, receiving compassion from others, and compassion for oneself, or self compassion. It is important to help people cultivate compassion across the three flows, however, certain fears, blocks and resistances to compassion can also be present across the three flows, and a big part of CFT is working with these fears to allow compassion then rather naturally be expressed and received.
Compassion focused therapy is an evolutionary-based approach to psychotherapy, but when we talk about CFT we are often including compassionate mind training, which is the psychoeducation and skill development components of CFT. CFT often involves more detailed assessment and case formulation, and can be offered individually or in groups. CMT is more of a set course and can be offered as a standalone intervention, often in a group.
As a therapist, I have a particular bent towards compassion focused therapy, but I do want to acknowledge that there is wonderful evidence emerging about the benefits of cultivating compassion and self-compassion across various approaches, such as mindful self-compassion, compassion cultivation training, and loving kindness and compassion meditations among a number of others.
Last quick point is that the evidence is still emerging. In fact, it’s exciting times in the science of compassion, self-compassion and certainly CFT. Lots of studies are underway around the world. But the evidence base already is very persuasive. So here goes: 5 evidence-based benefits of CFT!
1. CFT helps reduce self-criticism, worry and rumination
CFT was developed to help reduce self-criticism, which is the tendency to set unrealistically high standards for oneself and adopt a punitive stance when these standards are not met. Paul Gilbert and Chris Irons described working with self-criticism via CFT in their 2005 chapter Focused therapies and compassionate mind training for shame and self-attacking in the book Compassion: Conceptualisations, Research and Use in Psychotherapy.
An early meta analysis by Leaviss & Uttley in 2012 found that CFT was, in fact, particularly helpful for people who are high in self-criticism.
But compassion is important for worry and rumination too. Worry involves repeated anticipatory thoughts of potential future threats and imagined catastrophes. Rumination involves persistent, and recurring intrusive thoughts pondering the causes, meanings and consequences of the distress without actively problem-solving or changing the circumstances.
A 2021 paper by Lara Gama, myself, Marcela Matos and Mark Boschen found that having high fears of being compassionate towards oneself and/or receiving compassion from others increased the effect of self-criticism, worry and rumination on depression. So, it seems that cultivating compassion and self-compassion, and reducing fears of compassion, is very helpful for managing the effect of repetitive negative thinking styles.
2. CFT helps improve depression, anxiety and stress, as well as other mental health problems.
Of course, the relationship between self-criticism and depression is well-established. And depression itself is a widespread and often debilitating condition. Self-criticism, worry and rumination all seem related to depression, anxiety and stress as well. But compassion and self-compassion help!
James Kirby, Cassie Tellegen and I published a meta-analysis in 2017 that found that compassion-based interventions produced significant improvements in self-compassion and mindfulness, but importantly also significant improvements in anxiety, depression, psychological distress, and overall wellbeing.
A 2021 systematic review by Craig, Hiskey and Spector found that CFT shows promise in conditions with underlying shame and self-criticism, of course, many forms of psychological distress do involve underlying shame and self-criticism, with encouraging results across severe and complex mental health problems, such as depression, but also forensic populations, eating disorder populations, and people diagnosed with personality disorders.
3. CFT helps reduce shame
Whenever trials are carried out to test the effectiveness of CFT, shame is measured, and the Craig et al 2021 systematic review highlights several trials that have demonstrated reductions in shame following CFT.
A 2021 study by Marcela Matos and her colleagues found that participating in a compassionate mind training course led to reductions in self-criticism and shame by increasing participants’ self-compassion and openness to receiving compassion from others, and by reducing participants’ fears of self compassion and compassion from others. CFT and CMT work very well with shame.
If you are interested, Marcela Matos and I published a single case study in 2020 called “You are already all you need to be”: A case illustration of compassion focused therapy for shame and perfectionism, in the Journal of Clinical Psychology that outlined a CFT assessment, formulation and treatment plan for working with shame and perfectionism.
4. Compassion helps reduce body-weight shame
One particular type of shame has been receiving particular research attention over recent years, and that is body-weight shame. People who have bigger bodies often experience body weight shame and are at increased risk for mental health vulnerabilities such as depression and anxiety. In fact, lots of people experience shame related to their bodies, and this can be a major source of suffering.
Alicia Carter and her colleagues published a pilot trial of compassion-focused therapy for body weight shame in 2020, showing that CFT increased compassion and helped reduce body weight shame. One of the interesting qualitative findings in this study was just how helpful the group process was in de-shaming participants’ body image. So group CFT is often a great way to go.
This was a pilot study, but the results of a follow-up randomised control trial, that I was very fortunate to be involved with as a group facilitator, has been submitted for review. The study had some fascinating results, so stay tuned for that!
5. Compassion helps reduce trauma
Cultivating compassion across the three flows is very helpful for people who have experienced trauma. It seems particularly important to develop one’s competencies around self-compassion and being open to receiving compassion from others.
Ashfield and her colleagues published a qualitative study in 2021 that concluded that group CFT is particularly helpful, with the interrelationships in a group helping to shift self-perceptions, especially around trauma and shame.
They also found that CFT psychoeducation had a profound effect through helping people develop an understanding of themselves, their experiences and their difficulties.
And finally, participants highlighted the importance of developing compassion for others and themselves to aid them in safely accessing their emotions.
Two more pilot trials I have been involved in has involved group CFT with combat veterans diagnosed with post traumatic stress disorder, led by Maddie Romaniuk, and group CFT with adult female survivors of childhood sexual abuse, led by Lisa McLean. Both studies are making their way through the peer review process at the moment and I really can’t wait to share more details of the studies and their findings. In both cases CFT was very helpful in reducing PTSD symptoms and shame.
Note: McLean, Steindl & Bambling (2022) is now out!
The evidence base around the mental health benefits of CFT is growing fast. While more is needed, compassion focused therapy and compassionate mind training, delivered individually or as a group, helps reduce self-criticism, worry and rumination, depression, anxiety and other psychological stress, shame, and in particular body weight shame, and trauma or post traumatic stress. There’s a lot of exciting work happening in the field, trialing CFT in a whole range of populations. So keep watching this space.