Research Paper

A narrative review exploring the

effectiveness of Compassion-Focused
Therapy
Elaine Beaumont & Caroline J. Hollins Martin

Content & Focus: This narrative review summarises findings of research that has shown use of Compassion-
Focused Therapy (CFT) to improve psychological outcomes in clinical populations. This article reviews the
research studies that have utilised CFT to treat clients experiencing a variety of mental health issues. The
paper begins offering an overview of CFT theory and compassionate mind interventions. A literature search
was conducted which included book chapters and articles that discussed compassion focused therapy. Twelve
studies were identified which showed significant psychological improvements in clients with diagnosed trauma
symptoms, brain injury, eating disorders, personality disorders, schizophrenia-spectrum disorder, chronic
mental health problems and psychosis, both within groups and during one-to-one therapy. Within the context
of the reviewed studies, CFT has shown itself to be an effective therapeutic intervention when combined with
approaches such as Cognitive Behavioural Therapy (CBT).
Conclusion: The research design of the majority of the studies examined precluded determining the extent of
individual contributions that CFT made towards client recovery. Further research that uses more rigorous
approaches are required to evaluate more effectively the role CFT plays in clients’ therapeutic recovery.
Keywords: Compassion-Focused Therapy (CFT); Compassionate Mind Training (CMT); Self-compassion;
clinical outcome measure; narrative review.

Compassion-Focused Therapy

O
VeR tHe last DeCaDe there has gilbert (2009), CFt has been designed to
been an increase in the amount of increase awareness and understanding of
research that has explored the bene- human innate automatic reactions to threats
fits of cultivating compassion (germer & within the environment, with the underpin-
siegel, 2012; gilbert, 2010, 2009, 2000; ning principle to motivate the client to care
Hutcherson, seppala & gross 2008; leary et for their own well-being, increase sensitivity
al., 2007; lutz et al., 2008; Neff & Vonk, to their personal needs, and develop warmth
2009; Neff, Hsieh & Dejitterat, 2005; Rein, and understanding for self. over recent
atkinson & mcCraty 1995). With the years there has been an increase in the use of
evidence-base in mind, this paper intends to third-wave CBt approaches, such as mind-
look at what the literature says about fulness (segal et al., 2001), Compassion-
Compassion-Focused therapy (CFt) and its Focused therapy (gilbert, 2005) and
ability as a therapeutic intervention to acceptance and commitment therapy
enhance psychological outcomes in clinical (Pierson & Hayes, 2007).
populations. at present there is a growing body of
Compassion-Focused therapy was evidence within the health care community
initially developed to help people with that suggests that developing feelings of
chronic and complex mental health compassion for self and others can have a
problems linked to high levels of shame and profound impact on physiology, mental
self-criticism (gilbert, 2009). according to health and well-being (Harman & lee, 2010;

Counselling Psychology Review, Vol. 30, No. 1, March 2015 21

© The British Psychological Society – ISSN 0269-6975
Elaine Beaumont & Caroline J. Hollins-Martin

gilbert & Irons, 2004; gilbert et al., 2006). sessions, and are designed to help the client
For example, CFt has been shown to become their ‘own therapist’. In addition,
increase immune system effectiveness setback plans are formulated that involve
(Klimecki et al., 2012; lutz et al., 2008), asking questions such as:
lower blood-pressure and cortisol release l What kind of situation could ‘set you
(Cosley et al., 2010), reduce paranoid back’?
ideation (lincoln et al., 2012), moderate l How could your compassionate-self deal
negative emotions associated with Cluster C with a set back?
personality disorders (schanche et al., Individuals are encouraged to employ self-
2011), and improve general psychological soothing techniques, with the therapist
well-being (Neff & germer, 2012). focused on identifying strengths, positive
In contrast to other therapeutic attributes and good coping strategies
approaches, CFt employs self-soothing tech- (gilbert & Irons, 2004; gilbert et al., 2006).
niques, and individuals benefit from these’ the CFt process involves the therapist
which are designed to develop empathy, listening warmly and acknowledging and
compassion and loving kindness (gilbert & validating clients’ emotions and personal
Irons, 2004; Harman & lee, 2010; Neff et al., meanings (gilbert, 2009; gilbert & Irons,
2007) towards themselves. CFt processes are 2004; lee, 2009b). Whereas CFt describes
informed by the evolutionary model and the process and theory of applying the
psycho-education and seek to depersonalise model to therapy, compassionate mind
and de-shame by helping the client under- training (Cmt) is an element of CFt which
stand how their brain regulates emotion. focuses on activating the self-soothing system
the theoretical background of this by using a variety of interventions.
approach draws on evidence from neuropsy- therapeutic interventions may include
chology, attachment theory, evolutionary compassionate letter writing, building a
psychology, social psychology and compassionate image, examining compas-
Buddhism, and aims to help the individual sionate behaviour and exploring compas-
self-sooth and develop acceptance and sionate ways of thinking. In addition,
empathy for their suffering (gilbert, 2009). mindfulness techniques may be incorpo-
once the client stops condemning and rated to help the client focus on what the
blaming themselves for their symptoms, brain is sensing ‘in the now’, instead of rumi-
thinking and feelings, they are freer to nating on past events (segal et al., 2001).
progress towards taking responsibility and
learning to cope. Purpose of the review
Cognitive Behavioural principles are CFt is a new and flourishing style of therapy,
incorporated into therapy, for example, at which is currently not widely available in the
commencement of therapy the therapist UK or the extended international market.
conducts an assessment and develops a case to increase awareness of the worth of CFt,
formulation and treatment plan in collabo- the objective of this paper was to present a
ration with the client. Psycho-education is synopsis of studies to assist therapists’ under-
essential and the role behaviour, physiology, standings of how CFt has been successfully
cognitions and emotions play are examined used and where developments in the body of
and the basic evolutionary model that under- research are required. the research ques-
pins CFt is explored to help the client tions asked included: (1) Is CFt an effective
understand how their body is responding to therapeutic intervention; and (2) What are
perceived threat. socratic dialogue, guided the benefits of using CFt as an adjunct to
discovery, exploration of goals and home- psychotherapy and CBt?
work activities are incorporated into CFt

22 Counselling Psychology Review, Vol. 30, No. 1, March 2015

 A narrative review exploring the effectiveness of Compassion-Focused Therapy

Method excluded, because the objective was to

a review of the literature was undertaken to explore the effectiveness of CFt as a therapy
identify and summarise relevant research to treat clinical populations.
observations of the effectiveness of CFt
either standalone or as an adjunct to other Search strategy
therapies. Narrative reviews are an essential Data bases explored included meDlINe,
part of scientific enquiry because they PsychINFo, CINaHl, Cochrane Database
combine results from a variety of studies, and google scholar. Key words and search
therefore giving them a value that no single terms included were:
study can have (Baumeister & leary, 1997). l Compassionate mind training;
this method of review was considered suit- l Compassion-Focused therapy;
able because it provides a historical account l self-Compassion.
of the development of a theory, offers an the authors wanted to include both qualita-
overview of research in a particular area, and tive and quantitative methods and so a strict
as such is a valuable method of pulling hierarchy of evidence was not applied.
together what is known about a particular the initial review identified 885 papers,
phenomenon in the broader sense, such as but after closer examination was reduced to
for a grant proposal or as a resource to ther- 13. studies were excluded because they did
apists (Baumeister & leary, 1997). Narrative not focus on examining CFt therapy
reviews, therefore, can be a valuable building outcomes with a clinical population. studies
technique and can tell a trustworthy story, that did not incorporate compassionate
aiming to identify and critically analyse mind interventions as per gilbert’s model
research (Popay et al., 2006). were also excluded. For example, research
our purpose was to simply inform the papers which focused on non-clinical
field about what is already known about CFt samples, compassion fatigue or student
and its ability to treat clinical populations. populations were excluded from this review.
Having justified the choice of method, the Finally a further study was excluded (gilbert
ultimate aim of this review was to produce a & Irons 2004) as this was a pilot study which
paper to educate therapists about the state of aimed to explore how individuals experience
knowledge on the topic of CFt and its ability self-criticism on a daily basis, as opposed to
to improve clients’ situation. examining CFt as a treatment intervention.
to view a summary of the 12 studies
Ethical considerations reviewed, see table 1 overleaf.
Published data were used in preparation of Participants in the studies presented with
this manuscript, hence no ethical approval was (a) mental health problems (2 studies), (b)
required (Hollins-martin & martin, 2013). psychosis (3 studies), (c) trauma symptoms
(4 studies), (d) eating disorders (1 study),
Results/Findings and (e) personality disorders (1 study), and
the review was conducted between January (f) CFt-group approach for acute inpatients
and may 2014. all titles, abstracts and full- (1 study). a summary of the literature that
text of studies identified were screened for addressed use of CFt with participants expe-
potential inclusion. Primary research riencing mental health problems follows.
directly related to CFt therapy and its
outcomes were examined. Papers required (a) CFT and its effectiveness at treating
to be published in english and as CFt is a individuals with mental health problems
relatively new concept any studies that had two of the 12 studies support the effective-
been published before 2014 were included. ness of CFt at treating clients with chronic
studies which focused on non-clinical mental health problems (gilbert & Proctor,
samples and/or student populations were 2006; Judge et al., 2012).

Counselling Psychology Review, Vol. 30, No. 1, March 2015 23

 Table 1: Summary of the findings from studies using CFT as a therapeutic intervention.

24
Study Country Research method/design Number Participant information Treatment type and length Measures General findings
Gilbert & Proctor (2006) UK Pre-post study. 6 Individuals attending a day 12 (2 hour) sessions of group Weekly diaries, CMT reduced self-criticism,
2-month follow-up. hospital with chronic mental CMT. Individuals were HADS,FSCS, FSCRS, shame, sense of inferiority and
Quantitative. health problems supported within a OAS, SCS, SBS, SRV. depression and anxiety.
Self-monitoring diary. (39 to 51 years old). CBT programme. Increased self-compassion and
reassurance.
Judge et al. (2012) UK Pre- and post- measures. 27 clients Group CFT in a heterogeneous 12 to 14 sessions of group CFT Weekly diaries, BDI, Significant reductions were
Weekly diary. in 5 groups group of clients presenting with (2 hours). BAI, FSCR, FSCS, ISS, found for depression, anxiety,
severe mental health OAS, SBS, SCS. stress, self-criticism, shame,
difficulties. TAU from CMHT. submissive behaviour, and
social comparison post-
intervention.
Mayhew & Gilbert (2008) UK Case Series. 3 CMT for people who hear 12 1 hour weekly sessions plus Weekly diaries, BAVQ, CMT appeared to have a major
Quantitative. malevolent voices. TAU from Community Mental VRQ, SeCS, SCL-90, effect on participants’ hostile
Weekly diary. Health teams. FSCRS, FSCS. voices, transforming them into
6-month follow-up. becoming more reassuring, less
Elaine Beaumont & Caroline J. Hollins-Martin

persecutory and less

malevolent.
Braehler et al. (2012) UK Prospective, RCT. 40 Individuals with a 16 sessions of group therapy. BDI-11, PANAS, FORSE, Group CFT was associated with
Mixed method design. schizophrenia-spectrum CFT plus treatment as usual PBIQ-R, CGI-1,NRSS greater observed clinical
Pre-post study. disorder (TAU N=22) or TAU (N=18). improvement and an increase
in compassion and reduction
in feelings of shame.
Laithwaite et al. (2009) UK Pre-, mid-, post- and 18 male Patients with psychosis residing 3 groups over 10 weeks SCS, OAS, SeCS, BDI, An improvement in depression,
6-week follow-up. in a maximum-security (twice per week). RSE, SIP-AD, PANSS self-esteem, and rating of self-
Quantitative. hospital. compared with others, and a
reduction in shame, and
general psychopathology.
Significant changes were not
found on the SCS, SeCS or the
SIP-AD.
Ashworth et al. (2011) UK Case Study. 1 23-year-old woman – Integration of CFT into a CBT BAI-11, BDI, SCQ CBT was of limited
Quantitative. traumatic brain injury 3 years programme (6 sessions of CBT STAXI-AI effectiveness. CFT useful and
prior to attending and 18 sessions of CFT). showed positive change –
rehabilitation. helping the client develop
feelings of warmth and
kindness.

Counselling Psychology Review, Vol. 30, No. 1, March 2015

 Table 1: Summary of the findings from studies using CFT as a therapeutic intervention (continued).

Beaumont et al. (2012) UK Comparative Study. 32 Trauma victims. 12 sessions. 16 participants HADS, SeCS, IES-R Significant reductions in
Pre-post study. received CBT therapy only and anxiety, depression and trauma
16 received CBT and CMT. symptoms post-therapy.
No significant difference
between treatment groups.
Significant higher SeCS scores
in the CBT/CMT group post-
therapy. CMT may be a useful
addition for clients suffering
Quantitative with trauma symptoms.
Bowyer et al. (2014) UK Case Study. 1 17-year-old – PTSD. Trauma-focused CBT. PDS, BDI, OAS, FSCRS CFT enhanced TF-CBT.
Quantitative. 14 sessions x 1 hour and Reductions in PTSD, shame,
Pre-post study. 4 sessions x 1.5 hours. self-attacking and depressive
symptoms.
Beaumont & Hollins-Martin (2013) UK Case Study. 1 58-year-old man – signature- CMT and EMDR – 8 sessions. HADS, SeCS, IES-R Compassion-focused EMDR
Pre-, post- and signing phobia and trauma. resulted in an elimination of
9-month follow-up. the client’s signature-signing
phobia and a reduction in
trauma-related symptoms.
Effects were maintained at
follow-up.

Counselling Psychology Review, Vol. 30, No. 1, March 2015

Gale et al. (2012) UK Quantitative. 139 Individuals with eating CFT was introduced into a CBT EDE-Q, SEDS, Significant improvements on
Pre-post study. (101 sets disorders. 2 step programme. CORE-OM all subscales. Individuals
of scores) Step 1=2 hours per week for diagnosed with bulimia
4 weeks (psycho-education). nervosa particularly benefited
Step 2=20 sessions over from the programme.
16 weeks.
Lucre & Corten (2012) UK Mixed method. 8 Individuals diagnosed with 16 weeks of CFT-group therapy. SCS, FSCRS, SBS, OAS, CFT delivered in a routine
Pre-post scores. personality disorders with DASS21, CORE psychotherapy department for
12-month follow-up. previous experience of PD was beneficial.
therapy. Improvements were
maintained at 12-month
follow-up.
Heriot-Maitland et al. (2014) UK Pre-post study. 57 sets Inpatients in acute mental 22 sessions over a 6 month Likert Scale (level of A significant decrease in
Semi-structured interview. of scores health setting. period. Group CFT. distress and calmness). distress ratings and significant
increase in calmness ratings.
BAI=Becks Anxiety Inventory. BAVQ=Belief About Voices Questionnaire. BDI-II=Becks Depression Inventory. CGI-I=The Clinical Global Impression-Improvement Scale. CORE-OM=Clinical Outcomes in Routine Evaluation. DASS21=Depression Anxiety
and Stress Scale. EDE-Q=Eating Disoders Examination Questionnaire. FORSE=Fear of Recurrence Scale. FSCRS=Forms of Self-Criticizing/Attacking and Self-Reassuring Scale. FSCS=Functions of the Self-Criticizing/Attaching Scale. HADS=Hospital
Anxiety and Depression Scale. IES-R=Impact of Events Scale Revised. ISS=Internalized Shame Scale. NRSS=Narrative Recovery Style Scale. OAS=Other as Shamer Scale. PANAS=Positive and Negative Affect Scale. PANSS=Positive and Negative

25
A narrative review exploring the effectiveness of Compassion-Focused Therapy

Syndrome Scale. PBIQ-R=Personal Beliefs about Illness Questionnaire-Revised. PDS=Post Traumatic Diagnostic Scale. RSE=Rosenberg Self-Esteem measure. SBS=Submissive Behaviour Scale. SCL-90=a symptom inventory. SCS=Social Comparison
Scale. SCQ=Self Concept Questionnaire. SeCS=Self-Compassion Scale. SEDS=Stirling Eating Disorders Scale. SIP-AD=Self-Image Profile for Adults. SRV=Social Rank Variables. STAXI-AI=State Trait Anger Expression Inventory. VRQ=Voice Rank Scale.
Elaine Beaumont & Caroline J. Hollins-Martin

(1) gilbert and Proctor (2006) used a (3) mayhew and gilbert (2008) present
group-therapy approach to help individuals individual case-studies that explore three
experiencing high-shame and self-criticism. clients’ with auditory hallucinations and
Participants’ received 12 two-hour CFt their acceptance of CFt. Between sessions
sessions supported within a CBt pro- clients recorded auditory hallucinations, and
gramme. a weekly diary was also completed their critical and compassionate thoughts
to assess participants’ self-attacking and self- towards self. CFt focused on helping them
soothing behaviours. Post-therapy, a signifi- develop empathy for fear and distress felt,
cant reduction in depression (p<0.03), and also to develop tolerance and compas-
anxiety (p<0.03), self-criticism (p<0.03), sion for their fears through generating
shame (p<0.03), inferiority and submissive warmth and self-acceptance in response to
behaviour (p<0.05) were found. also their self-critical thoughts. Results recorded
recorded in the diaries was discourse that a decrease in depression, psychoticism,
relates to an increase in feelings of self- anxiety, paranoia, obsessive-Compulsive
warmth, reassurance for self and self-care. Disorder (oCD) and interpersonal sensi-
there was no significant change in self- tivity. In response to CFt therapy, all three
correcting and self-attacking scores. one participants’ auditory hallucinations became
limitation of the gilbert and Proctor (2006) less malevolent, less persecuting and more
study was the small participant group (N=6). reassuring. a surprising finding from this
However, this study presents as a pilot, with study was that two participants’ self-compas-
room for repetition and validation in similar sion and self- criticism scores as measured by
contexts. the self-Compassion scale (Neff 2003) did
(2) Judge et al. (2012) found significant not reflect their diary sheet scores. all partic-
reductions post CFt therapy in symptoms of ipants rated themselves as highly self-
depression, anxiety, stress, self-criticism, compassionate at commencement of therapy
shame, submissive behaviour and social but later reported that they had not under-
comparison in individuals (N=27) attending stood ‘self-compassion’ until they started to
group therapy (seven groups with an average engage in Cmt.
of (N=5) per group). the analyses revealed (4) Braehler et al. (2012) conducted a
significant improvements in scores for all of Randomised Clinical trial (RCt) that
the study variables with the exception of the compared outcomes of a CFt group (N=22)
self-correction sub-scale. the authors and a treatment as Usual (taU) group
propose that self-correction could possibly (N=18) in clients diagnosed with schizo-
be seen as a positive, preventing people from phrenia-spectrum disorder. therapy focused
becoming too arrogant or as a way of helping on reducing symptoms of shame and self-
maintain their standards. CFt had a signifi- criticism and developing self-compassion.
cant impact at reducing depression, anxiety, Post 16-weekly sessions, the CFt group
and internal and external shame in clients’ showed greater observed clinical improve-
experiencing chronic mental health ments (p<0.001). a significant increase in
problems. additional qualitative data compassion (p=0.015) was associated with
supported that CFt was easily understood, significant reductions in depression
helpful and well-tolerated by clients. (p=0.001), and a decrease in perceived social
marginalization (p=0.002). When treatment
(b) CFT and its effectiveness at treating scores were compared at the end of therapy
people with psychosis there was a significant increase in compas-
three of the 12 studies support the effec- sion (p=0.02) compared to non-significant
tiveness of CFt at treating clients with small effects in taU. although further
psychosis (mayhew & gilbert, 2008; laith- studies are required to validate these find-
waite et al., 2009; Braehler et al., 2012). ings, using CFt as a therapeutic intervention

26 Counselling Psychology Review, Vol. 30, No. 1, March 2015

 A narrative review exploring the effectiveness of Compassion-Focused Therapy

with individuals with schizophrenia-spec- symptoms between a group that received

trum disorder has shown to be an effective Cmt and CBt (N=16), and a CBt only
and safe form of therapy. group (N=16). Participants in both treat-
(5) laithwaite et al. (2009) evaluated a ment groups experienced statistically signifi-
10-week CFt programme that included cant reductions post-therapy in symptoms of
(N=19) clients diagnosed with psychosis who anxiety (p<0.001), depression (p<0.001),
were residing in a high security setting. avoidance (p<0.001), hyper-arousal
By the end of the programme significant (p<0.001) and intrusive thoughts (p<0.001).
improvements in social comparison However, there was no significant difference
(p<0.05), self-esteem (p<0.01), shame between treatment groups. Participants in
(p<0.05), and depression (p<0.05) were the CBt/Cmt condition developed statisti-
achieved. significant differences in self- cally significant higher self-compassion
compassion and self-concept were not scores post-therapy than the CBt-only
found, leading the authors to conclude that group. the main effect comparing the two
the self-report of compassion could be types of treatment was significant
different for individuals who have lacked the [F(1,30)=4.657, p≤.05] suggesting higher
experience of compassion from others levels of self-compassion post-therapy in the
during critical periods of their development. CBt/Cmt group..
Further replication of this study could (8) Bowyer et al. (2014) used Cmt to
involve a waiting list control group and a enhance trauma-focused CBt with a 17-year-
larger sample size. old girl who was sexually assaulted at the age
of 13. Post-therapy, there was an increase in
(c) CFT and its effectiveness at treating self-reassurance, with reduced PtsD, depres-
symptoms of trauma sion, self-attacking behaviours and shame.
Four of the 12 studies supported effective- again, assembling an anthology of case-
ness of CFt at treating clients with symptoms reports with similar findings will help vali-
of trauma (ashworth et al., 2012; Beaumont date use of Cmt adjacent to trauma-focused
et al., 2012; Bowyer et al., 2014; Beaumont & CBt.
Hollins martin, 2013). (9) Beaumont and Hollins martin (2013)
(6) ashworth et al. (2011) reported that propose that Cmt can be used as a resource
CBt had limited effect on Jenny who had in eye movement Desensitization and Repro-
experienced traumatic brain injury. In cessing (emDR). In the Beaumont and
contrast to CBt, CFt helped reduce depres- Hollins martin (2013) single-case report,
sion and anxiety, improve validation of ‘self’, emDR was used to treat a 58-year-old man
increase acceptance of difficulties, raise self- who presented with psychological distress
esteem, and reduce anger. Ratings of beliefs and somatic symptoms post-trauma. emDR
relating to key cognitions also improved. combined with Cmt facilitated recall of
the cognition ‘I am worthless’ fell to 10 per forgotten memories about the client’s sister’s
cent from 100 per cent by the end of therapy. traumatic death, with emotions of shame
It is important to note that Jenny was treated and grief creating insight into how past
in the context of a holistic rehabilitation events linked to a current signature-signing
program. therefore, it cannot be assumed phobia. the combined emDR/Cmt
that the clinical changes observed are due approach was implemented to reduce threat
only to CFt interventions. However, devel- of rejection, self-criticism, and self-attack
oping a portfolio of case studies would work (Wheatley et al., 2007). this client
towards validating the findings of this single- responded well to strategies used to increase
case report (Fishman, 2005). self-compassion and tackle the ‘critic within.’
(7) Beaumont et al. (2012) compared eight sessions of compassion-focused emDR
outcomes of clients with trauma-related eliminated the client’s signature signing

Counselling Psychology Review, Vol. 30, No. 1, March 2015 27

Elaine Beaumont & Caroline J. Hollins-Martin

phobia, reduced his anxiety and trauma is difficult to identify the specific aspects of
related symptoms, and elevated his mood the CFt programme that accounted for the
and self-compassion. these effects main- significant changes in the self-report meas-
tained at 9-month follow-up. a multiple base- ures. However, improvements were main-
line case study could be used in future tained at one-year follow-up.
research to examine the individual contribu-
tions of Cmt and emDR. (e) CFT and its effectiveness at treating
individuals in acute in-patient settings
(d) CFT and its effectiveness at treating one of the 12 studies supported effective-
individuals with eating disorders ness of CFt for treating clients in acute in-
one of the 12 studies supported effective- patient settings (Heriot-maitland et al.,
ness of CFt for treating clients with eating 2014).
disorders (gale et al., 2012). (12) Heriot-maitland et al. (2014)
(10) gale et al. (2012) measured assessed the impact of 22 CFt group sessions
outcomes between 2002-2009 from inte- delivered over a six-month period to patients
grating CFt into a standard CBt (N=82) in an acute unit. Participants rated
programme for clients with eating disorders their pre- and post-session levels of distress
(N=139). and calmness on a six-point likert scale,
In total, 73 per cent of clients with which produced 57 datasets. Results found a
bulimia nervosa, 21 per cent with anorexia significant reduction in levels of distress
nervosa, and 30 per cent with atypical eating (p=0.005) and a significant increase in
disorders reported significant improvements overall calmness post-session (p=0.05) partic-
in their eating disorders by end of treatment. ularly within a session which focused on
the results of the study suggest that individ- imagery (p=0.019). Qualitative data themes
uals with eating disorders can benefit from a produced were labelled ‘understanding
compassion-focused approach. However, compassion’, ‘experience of positive affect’
due to issues surrounding missing data only and feelings of a ‘common humanity’.
99 people who completed the programme a limitation of this pilot study is that it did
had pre- and post-scores at the end of treat- not use standardised outcome measures.
ment. However, comments from the individuals in
the group offered rich data regarding client
(e) CFT and its effectiveness at treating experience of therapy.
individuals with personality disorders
one of the 12 studies supported effective- Discussion
ness of CFt for treating clients with person- strengths and limitations of the studies
ality disorders (lucre & Corten, 2012). examined and identified areas for future
(11) lucre and Corten (2012) measured research follow. First, the research questions
the responses of clients with diagnosed were supported by the findings of this narra-
personality disorders (N=8) who had tive review. CFt has shown itself in the
completed a 16-week course of CFt context of the reviewed studies to be an
informed by CBt. a significant reduction in effective therapeutic intervention. also,
depression (p<0.05), stress (p<0.05), shame analysis has demonstrated benefits of using
(p<0.05), social comparison (p<0.01), self- CFt as an adjunct to psychotherapy and
hatred (p<0.01), and an increase in self-reas- CBt. In essence, the evidence examined
surance, well-being and social functioning supports that people referred for psycho-
(p<0.01) were reported. Qualitative feedback logical intervention may benefit from
informed that participants found CFt developing self-compassion.
helpful, with benefits upheld at one-year three of the studies examined were case
follow-up. a limitation of this study is that it studies (ashworth, 2011; Beaumont et al.,

28 Counselling Psychology Review, Vol. 30, No. 1, March 2015

 A narrative review exploring the effectiveness of Compassion-Focused Therapy

2012; Bowyer et al., 2014), one was a case aspects of CFt works and with whom.
series (mayhew & gilbert ,2008), and a other aspects that require exploration
further three had ‘sample sizes’ of (N=20) or include, mismatches between clients’ diary
under (gilbert & Proctor, 2006; laithwaite et reports and their self-compassion scores. For
al., 2009; lucre & Corten, 2012). yet, example, mayhew and gilbert (2008) report
because of small samples and lack of rigour that self-compassion scores in their study did
from tight control groups, generalisation of not mirror participants’ diary sheet scores.
findings to the wider population becomes also, some clients’ rated themselves as highly
problematic. also there is ambiguity about self-compassionate, and later in therapy
whether or not changes in self-compassion reported that they did not understand what
were in fact due to the CFt therapy alone. the term meant. this highlights the impor-
Due to therapy being combined with emDR tance of clearly defining the term ‘compas-
or CBt in some of the studies cited, it is sion’ and assessing client comprehension
advised that further research examines throughout therapy and before CFt
stand-alone CFt in clinical contexts. commences. In addition, for the evidence-
also, without a treatment control group base to develop, it is important to gather
(Braehler et al 2012), it is difficult to deter- follow-up data to ascertain longevity of
mine if individuals improved as a direct scores.
result of the CFt or because of external a variety of measures and questionnaires
factors (Corney & simpson, 2005), such as were used in the 12 studies (refer to table 1)
personality type, social support, relapse including:
prevention, relapse indication issues and/or l Functions of the self-Criticizing/attack-
individual resilience. Increasing sample sizes ing scale (gilbert et al., 2004)
and taking a gold standard RCt approach is l Forms of self-Criticizing/attacking and
essential to further validate effectiveness of self-Reassuring scale (gilbert et al., 2004)
the CFt technique (mcleod, 2010). to our l self-Compassion scale-short Form (Raes
knowledge effect sizes quantifying the differ- et al., 2010)
ence between groups and the effectiveness l self-Compassion scale (Neff, 2003)
of the treatment intervention was not l other as shamer scale (goss et al., 1994)
reported in all of the studies reviewed. l submissive Behaviour scale (allan &
Reporting effect sizes in research is valuable gilbert, 1997)
for quantifying the effectiveness of the inter- l social Comparison scale (allan & gilbert,
ventions examined (Huberty, 2002). 1995).
triangulating quantitative data with qual- a further question for researchers to
itative approaches also helps identify palata- consider is what outcomes measures are
bility of CFt at an individual level. For appropriate for future CFt research?
example, laithwaite et al., (2009) reported
that some clients struggled with compas- Conclusion
sionate imagery tasks. In contrast, Hariot- Counselling psychology welcomes the oppor-
maitland et al. (2014) reported that their tunity to integrate new developments within
imagery sessions were particularly well- existing therapeutic approaches and it is
received by inpatients, and that they received essential that new treatment options be
the lowest attrition rate (25 per cent) of all examined so that we as a counselling and
the therapeutic interventions used. these psychotherapy profession provide therapy
conflicting results, support that some indi- that meets the needs of clients referred for
viduals appreciate CFt imagery exercises, psychological intervention.
whilst others do not. Consequently, rich this review has shown benefits of using
detailed qualitative data is essential if thera- CFt to create a more affiliated orientation to
pists are to understand why particular ones-self and others. However, further

Counselling Psychology Review, Vol. 30, No. 1, March 2015 29

Elaine Beaumont & Caroline J. Hollins-Martin

research evidence in this area is needed in individual resilience and social functioning.
order to ensure that we as a therapeutic Introducing control groups, using larger
community offer the best treatment for sample sizes, implementing long-term follow-
those individuals referred to us for up and independent rating of changes in
psychotherapy. to date there is not enough outcomes would also improve rigour. also
evidence to suggest that CFt is as effective as needed are qualitative studies that explore
other psychotherapeutic interventions. what is helpful during delivery of CFt to
the CFt model is advantageous because enrich and develop skills of therapists from
it can be integrated into a CBt program or the ‘compassionate mind community’.
incorporated into other psychotherapeutic
frameworks. In conclusion, data provides About the Authors
promising support for the utility of CFt, with Elaine Beaumont
research already conducted an encouraging Cognitive Behavioural Psychotherapist,
starting point for exploring structured, time emDR europe approved Practitioner and
limited, compassion-focused interventions lecturer in Counselling and Psychotherapy,
for clients diagnosed with clinical condi- College of Health and social Care, mary
tions. seacole (Room ms3.17), College of Health
In terms of future research, there are a and social Care, University of salford, Fred-
number of research questions that remain erick Road, salford, greater manchester,
unanswered. For example: UK, m6 6PU.
1. What elements of CFt are the most email: [email protected]
effective, why and to whom?
2. What are the best measures of CFt? Caroline J. Hollins Martin
3. How effective is CFt when used as a Professor in maternal Health, school of
therapeutic intervention on its own? Nursing, midwifery and social Care,
In addition to examining symptom reduc- edinburgh Napier University, 9 sighthill
tion, further research is required to examine Court, edinburgh eH11 4BN.
improvements in quality of life, changes in email: [email protected]

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