Table 3.
Characteristics of included studies presented in chronological order.
| Study: authors, year, location | Design/study type | Study aim(s) | Participants | Intervention | Data collection* | Method of analysis | Main themes (Author Identified) | |
|---|---|---|---|---|---|---|---|---|
| 1 | Altavilla and Strudwick (2022) (46) UK |
Mixed methods study | To evaluate and provide recommendations to improve the effectiveness of an age inclusive CFT group in secondary mental health services for individuals experiencing a range of mental health difficulties. | Convenience sample (n = 6) of the 23 participants who had completed one of four CFT groups run by the service. 5 participants were female and one was male. Three were considered working age range (18-64 yrs), and three were considered older adult (over 65 yrs). All were white-British with English as their first language. All were under secondary mental health services (either working age or older adult) and experienced a range of psychological difficulties. They had also been identified as having long-standing struggles with self-criticism/self-blame. Participants were excluded from taking part in the group if they had a significant cognitive impairment, were currently experiencing psychosis, or if they were substance-dependent and their use of substances was likely to impact their ability to engage. | Age-inclusive CFT group facilitated by two experienced clinical psychologists, trained and with experience working in a CFT approach. Supervision from a CP experienced in working within a CFT model. The group programme was developed by facilitators based on existing CFT group literature and published protocols (18, 47, 48). N = 6-10 participants per group. Group ran for 20 sessions, mainly on a weekly basis. Each session lasted 2 ½ hours with a coffee break. Sessions organised by theme for consistency but delivered flexibly to respond to the needs of group members. At the halfway point, each group member was invited to meet with a facilitator for 30 min to work on an individualised formulation. They were also invited to another 30-min individual session at the end of the group programme to review their overall experience of the group and plan for next steps. | Qualitative data: Semi-structured interview Quantitative data: Self-report measures (completed pre, mid and post- intervention & at 3 mo f-up): Self-Compassion Scale (SCS), Mindful Attention Awareness Scale (MAAS), CORE-34 and Depression Anxiety and Stress Scale (DASS) |
Thematic analysis (49) | - Connection with others - The experience of diverse age - Group as a secure space |
| 2 | Gilbert et al. (2022) (9) UK |
Mixed methods feasibility and acceptability study | (To examine the patient experience and feasibility of a 12 module CFT group tailored for individuals with a diagnosis of bipolar disorder. | N= 10 service users of a specialist bipolar service with a clinical diagnosis of bipolar affective disorder, relatively stable in mood at time of participation in the study. Not all the participants took part in every focus group. | Group CFT for bipolar disorder based on CFT manual in preparation 1 with some adjustments for prior knowledge of participants. 12 sessions initially delivered over 14 weeks, a 20-week rest period and then another 13 sessions over 13 weeks. Delivered by 2 clinical psychologists, both trained and one with extensive experience in CFT and receiving regular supervision from Paul Gilbert. | Qualitative- Focus groups Quantitative data: Self-report measures: DASS, The Hospital Anxiety and Depression Scale (HADS), The Experiences Questionnaire- Decentering subscale (EQ), Positive Affect and Negative Affect Scale (PANAS), Three Types of Positive Affect Scale, Forms of Self-Criticism/Self-Reassuring Scale (FSCRS), Social Comparison Scale, Social Safeness and Pleasure Scale (SSPS), Compassion Engagement and Action Scale. Quantitative-Heart Rate Variability (HRV), measured using Biopack software in response to a series of imagined scenarios presented to participants ( relating to social rank, attachment, competition) interspersed with neutral scenarios. |
Thematic analysis (49) | - Understanding and utilising the evolutionary model - Experiences of the degree of helpfulness of the CMT exercises. - Using CFT to understand and address self-criticism - General experience of the therapeutic process and impact on managing moods and emotions; - Going forward & suggestions for the future. |
| 3 | Maynard et al. (2023) (12) New Zealand |
Qualitative study | To provide a more detailed understanding of participants’ experiences of change within the CFT groups, in relation to their experiences of self-forgiveness and psychological health. | N = 31 users of a community mental health service, described by authors as suffering from mild to moderate depressive symptoms and with low risk. Mean age of sample was 42.6 yrs (range 18-63 yrs). 39% male, 61% female. 29.3% single, 31.7% married, 28.8% divorced, 12.2% de facto relationship. 80.5% classified themselves as NZ/European, 12.2% as Maori, 2.4% as Pacific Peoples, 2.4% as either Latin American, Middle-Eastern/African origin, remaining 4.8% as another ethnic group. | 12-week CFT intervention based on the True Strength protocol for managing difficult emotions (12). Duration of each session was 2 hours with a 15-minute break. Sessions led by a consultant clinical psychologist. | Focus groups | Thematic analysis (50) with an inductive approach to coding | - Becoming self-compassionate and self-forgiving. - The CFT group was beneficial. |
| 4 | Ashfield et al. (2021) (10) UK |
Qualitative study | To investigate the mechanisms of change at an individual and group level for individuals completing a CFT-based intervention for individuals with complex PTSD | N = 11 service users with a diagnosis of PTSD attending a specialist PTSD service | Group CFT intervention for trauma based on CFT (1, 47, 51). Total number of session and intervention length not specified. Professional background and training of those delivering the intervention not specified. Supervision arrangements also not specified. | Interviews | Constructivist grounded theory (52)-based analysis of interview data |
Overall explanatory model: An ongoing journey of change Themes: - Experiences before the group - Overcoming barriers and readiness for change - The change process |
| 5 | Goad and Parker (2021) (53) UK |
Mixed methods study | To evaluate a CFT group intervention for people with intellectual disability experiencing low mood, high self-criticism, and feelings of shame | N = 6, service users with a diagnosed (mild) ID receiving support from an NHS Community ID service for difficulties with low mood, high self-criticism and shame. One participant also had diagnosed autism, another also had diagnosed autism and Attention-Deficit Disorder (ASD). | Extended version (11 sessions) of the 6-session group CFT intervention developed by Clapton et al. (54) for individuals with ID Delivered by a senior clinical psychologist with a high level of expertise and experience in delivering CFT. Supervision arrangements (if any) not specified. | Qualitative data: Focus groups Quantitative data: Self-report measures- CORE-LD, Adapted Social Comparisons Scale and the Self-Compassion Scale-Short Form |
Inductive thematic analysis (49) |
Focus group 1:
- Feedback obtained; - Developing compassion for self and others - Managing emotions - Developing connections Focus group 2: - Compassion to self - Compassion to others - Developing connection - Obtaining feedback |
| 6 | Raynor et al. (2022) (29) UK |
Mixed methods evaluation | (Of the qualitative component) To explore the impact of a ‘compassion-focused cognitive behavioural therapy group’ for people that self-harm. To provide a detailed exploration of the experiences of the participants in the psychotherapy group. | N=3 individuals (n = 3) aged 16+ who had self-harmed more than three times in the last year, residing in the community, recruited from accident and emergency, universities and further education colleges, mental health and other local charities. | 12 session psychotherapy group for people that self-harm integrating CFT (55) and CBT for self-harm (56) developed by four of the study authors. Delivered by behavioural psychotherapist, mental health nurse and a CBT therapist. Supervision provided by the first author (BABCP-accredited psychotherapist, mental health nurse and integrative counsellor Psychotherapist). | Qualitative data: Focus group Quantitative data: Self-report questionnaires: Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder-7 (GAD-7), the Self-Compassion Scale, (SCS), Cognitions of Self-Injurious Behaviour Scale completed at first and final sessions, then 3 month follow up. |
IPA (57) | - The secret’s out! Openness and honesty - Care without fear: calm acceptance, - Skills not spills - We’re all in it together (acceptance) - Compassion, not competition or comparison - Fear of ‘flying solo’ |
| 7 | Gooding et al. (2020) (58) UK |
Mixed methods evaluation | To explore the effectiveness of a 12-week CFT group intervention for people with persistent pain in a clinical setting considering group and individual change processes. | Adult service users (N = 4) with persistent pain attending an NHS pain management service.3 participants were male, 1 female, aged between 47 and 76 years. Participants scored in the clinically severe ranges for both depression and anxiety on the DASS-21 and in the moderate range for stress. | 12 session CFT group delivered over 12 weeks. Each session lasted two hours. This version of group CFT was based on Gilbert (1) and was adapted for the client group by clinical psychologists within the pain service where the intervention was being delivered, two of whom also facilitated the sessions. Any supervision arrangements in place were not described. | Qualitative data: Semi-structured interviews Quantitative data: Self-report questionnaires: DASS-21, The Forms of Self-Criticising/Attacking and Self-Reassuring Scale (FSCRS), The Chronic Pain Acceptance Questionnaire (CPAQ), The Pain Disability Index (PDI). |
IPA (57) | - The immense impact of pain on daily life - Meaning of connection and belonging in the group - Engaging with the emotions connected to the pain experience - Recognising the process of change in the group - Applying learning from the group. |
| 8 | Mullen et al. (2020) (59) Republic of Ireland |
Qualitative study | To explore service users’ experiences of attending a group CFT intervention for eating disorders as well as any possible changes in patterns of relating to self and others. | N= 9 service users meeting diagnostic criteria for eating disorder attending an outpatient clinic. | Group CFT intervention for eating disorders [CFT-E2, 8]. This intervention combines CFT with standardised CBT approaches to eating disorders [CBT-E, (60)]. The intervention comprises 24 sessions, 20 of which are delivered in a group format, 3 are individual review sessions and 1 is a friends and family session. Group sessions are between ½ a day and a full day in length. The intervention was delivered by two clinical psychologists. Supervision arrangements not specified. | Semi-structured interviews | Thematic analysis (49) and relational analysis (61). | - Flow of compassion and knowledge - Sharing, connecting, and belonging - Hope and trust - Structure and accountability - Strength, struggle and practice - Managing dilemmas |
| 9 | Clapton et al. (2018) (54) UK |
Mixed methods acceptability and feasibility | To preliminarily investigate and explore whether a CFT group intervention is feasible and acceptable for adults with ID who have concurrent mental health issues. | N = 7 service users with an ID receiving support from NHS Community Learning Disabilities Teams. Service users identified as experiencing significant psychological distress (≥13 on the relevant index of the Psychological Therapies Outcome Scale for IDs (62), and significant self-criticism. | Brief (6-session) group CFT intervention adapted for the client group by the first author (Clapton) from existing group-CFT interventions in the research literature and based on Gilbert et al. (2, 55). Each session lasts for 90 minutes. Time over which 6 sessions were delivered not specified. Group facilitated by a clinical psychologist with extensive training and experience with CFT who attends regular group supervision with Paul Gilbert. Group 1 was co-facilitated by a senior clinical psychologist, group 2 by a trainee clinical psychologist (both less experienced with CFT approaches). | Qualitative data: Focus groups Quantitative data: Self-report measures: i) For inclusion in the study- Psychological distress index of the Psychological Therapies Outcome Scale for IDs (PTOS-ID); ii) Pre and post intervention measures (completed pre-intervention and at 2 and 4 weeks post-intervention)- Self-Compassion Scale-Short Form (SCS-SF), The Psychological Therapy Outcome Scale for Intellectual Disabilities (PTOS-ID),The Adapted Social Comparisons Scale (ASCS), CFT-ID session feasibility and acceptability measure (bespoke measure). |
Thematic analysis (49) |
- ‘It’s like … you’re not on your own’- Experiences of the group intervention and process - ‘It’s hard to be kind to yourself when you’re always used to not being kind to yourself’ – Fears, blocks, and resistances to compassion. - ‘Looking at yourself from the inside’- Changes in relating to self, other and life experiences. |
| 10 | Ashworth et al. (2015) (63) UK |
Mixed methods feasibility and acceptability study | To assess the feasibility, safety, and potential value of CFT for ABI patients with emotional difficulties | N = 7 service users with acquired brain injury and mental health difficulties attending a neurorehabilitation unit as outpatients. | CFT (17)-informed intervention developed and tailored for the client group and setting by the study’s first author (Ashworth) who had completed training in CFT and received monthly supervision from Paul Gilbert during the initial development of the intervention. CFT intervention (entitled ‘mood group’) delivered as part of a holistic neurorehabilitation program for individuals who had experienced ABI. Intervention delivered by three clinical psychologists who had all attended Paul Gilbert’s 3-day training in CFT. All received supervision from another qualified clinical psychologist. | Qualitative data: Semi-structured interviews Quantitative data: Self-report questionnaires (collected pre and post-intervention and at 3 month follow-up): HADS, FSCRS |
IPA (57) | - Psychological difficulties - Developing trust and finding safeness - A new approach |
| 11 | Heriot-Maitland et al. (2014) (11) UK |
Mixed methods feasibility and acceptability study/service evaluation | To examine the acceptability and feasibility of providing a CFT-group intervention adapted for the inpatient environment. | N = 4 service users in an NHS acute inpatient psychiatric unit, most common diagnoses- schizophrenia, schizoaffective disorder, bipolar affective disorder, personality disorder, depression and anxiety. | CFT-informed (17) brief (4 session) group intervention adapted specifically for inpatient settings by study authors. Each session lasted 60 minutes and the intervention was delivered over 4 weeks. Intervention delivered by a clinical psychologist with training and experience in CFT who received regular supervision from a specialist CFT practitioner. A member of nursing staff from the ward or trainee clinical psychologist assisted with the delivery. | Qualitative data: Semi-structured interviews Quantitative data: Self-report measures: (Completed pre and post-session) Distress and calmness scales, (Completed post-session) Understanding and helpfulness ratings (bespoke 6-point measure). |
Thematic analysis (49) | - Common humanity and affiliative relating - Understanding compassion - Activating of positive affect - Experiences of the group |
| 12 | Lucre and Corten (2013) (7) UK |
Mixed methods pilot study | To evaluate the worth/value of a newly developed CFT groupwork programme for people with PD. | N = 8 service users with a Personality Disorder diagnosis (confirmed by a senior clinician in the service trained in the administration of the International PD Examination (a diagnostic instrument for PD) who also regarded themselves as ‘self-critical’ under the care of NHS secondary care services and referred to a specialist PD therapy service. | 16-session group CFT intervention delivered over 16 weeks (length of session not specified). Version of CFT was based on Gilbert (1) and adapted for the clinical group by the study authors. The intervention was delivered by an accredited cognitive- behavioural psychotherapist and a ‘band 4 group facilitator’. These group facilitators had received training and attended monthly supervision from Paul Gilbert for the duration of the intervention. | Qualitative data: Verbal and written feedback from participants Quantitative data: Self-report measures: Social Comparison Scale (SCS), Submissive Behaviour Scale (SBS), The Other as Shamer Scale (OAS), FSCRS, DASS-21, CORE-34. |
Content analysis (64) | - Taking responsibility for one’s thoughts and actions - The comfort of shared group experiences - Fear of compassion - Awareness of self-criticism and addressing it with assertive action |
1ABI, Acquired Brain Injury; ADD, Attention Deficit Disorder; BABCP, British Association for Behavioural and Cognitive Psychotherapies; CBT-E, Cognitive Behavioural Therapy for Eating Disorders; CFT, Compassion-Focused Therapy; CMT, Compassionate Mind Training; CP, Clinical Psychologist; DASS-21, the Depression Anxiety and Stress Scale- 21 items; ID, Intellectual Disability; IPA, Interpretive Phenomenological Analysis; PD, Personality Disorder; PTSD, Post-Traumatic Stress Disorder; NZ, New Zealand; UK, United Kingdom.
2For further details of/references for questionnaire measures, please consult the original papers.
*Please see author reference for questionnaire details.