. 2025 Jul 21;13:145. doi: 10.1186/s40337-025-01292-0

Table 3.

Table of synthesis of evidence based on review questions

Review question	Summary of results
How is CFT implemented in interventions targeting body image dissatisfaction among individuals with eating disorders, taking into account the stigma associated with both the disorders and body image issues?	Experiential studies looking into the effects of Compassion-Focused Therapy show group intervention plans typically last between 12–20 sessions long With the few studies who implemented their own CFT trials [43, 49], CFT was combined with CBT or Treatment as Usual (TAU), opposed to being a standalone intervention. CBT alone only achieves clinically significant improvements in about 50% of patients [10]; therefore, the addition of CFT may be useful in breaking the shame-symptom cycle existing for the remaining 50% of patients. This approach aims to capitalise on the strength of each therapeutic modality whilst addressing the unique emotional and relational factors underlying body image dissatisfaction by addressing stigma-related barriers to recovery One intervention included an outline of the intervention, a focus on psychoeducation, values clarification, experiential distancing acceptance and willingness, mindfulness, and compassion. Compassion was brought in at session 10 out of 12 [49] Another intervention introduced self-compassion earlier into the programme. This outline included an orientation to treatment with relevant psychoeducation, development of group purpose and the introduction of CBT model, self-monitoring and de-shaming discussions, focusing on ED risks with problem solving, introducing CFT and compassionate interventions imagery with distress tolerance skills, and relapse prevention. Compassion was brought in as a focus in session 7 out of 20 [43]
What are the key findings regarding the effectiveness of Compassion Focused Treatment in addressing body image dissatisfaction within eating disorder populations, considering the role of stigma?	The role of stigma exacerbates body image dissatisfaction and a drive for thinness, which can be an initial con for patients when deciding to commit to compassion-focused treatment. AN patients particularly worry how self-compassion may cause them to give up their efforts to conform to society’s ‘thin ideal’, despite perceived benefits in having more of a sense of self [47] Individuals who build a more compassionate self-to-self relationship show lower levels of body image dissatisfaction and reduced engagement in eating disorder behaviours [42−46, 48, 49] Individuals who have taken part in CFT treatment show reductions in internal shame, external shame and self-criticism, with an increase in self-compassion, impacting upon symptoms of eating disorder psychopathology [43, 49]. Further research is needed to understand these links to the role of the shame-symptom cycle maintaining ED pathology Self-compassion as a mediating factor in the relationship between external shame and drive for thinness, acting as a buffer against the effects of stigma – a potential use of compassion to help with feelings of inferiority and drive for thinness Those who experience larger decreases in their levels of shame and greater increases in their level of self-compassion in the first 4 weeks of treatment show faster decreases in their eating disorder symptoms over 12-weeks of treatment. Findings were found in a mixed sample of eating disorders (AN-R, AN-BP, BN, EDNOS – BED) [43] Participants who have a relatively low baseline fear of self-compassion had the greatest improvements in ED pathology and depressive symptoms when in self-compassion treatment [43]

Review question

Summary of results

How is CFT implemented in interventions targeting body image dissatisfaction among individuals with eating disorders, taking into account the stigma associated with both the disorders and body image issues?

Experiential studies looking into the effects of Compassion-Focused Therapy show group intervention plans typically last between 12–20 sessions long

With the few studies who implemented their own CFT trials [43, 49], CFT was combined with CBT or Treatment as Usual (TAU), opposed to being a standalone intervention. CBT alone only achieves clinically significant improvements in about 50% of patients [10]; therefore, the addition of CFT may be useful in breaking the shame-symptom cycle existing for the remaining 50% of patients. This approach aims to capitalise on the strength of each therapeutic modality whilst addressing the unique emotional and relational factors underlying body image dissatisfaction by addressing stigma-related barriers to recovery

One intervention included an outline of the intervention, a focus on psychoeducation, values clarification, experiential distancing acceptance and willingness, mindfulness, and compassion. Compassion was brought in at session 10 out of 12 [49]

Another intervention introduced self-compassion earlier into the programme. This outline included an orientation to treatment with relevant psychoeducation, development of group purpose and the introduction of CBT model, self-monitoring and de-shaming discussions, focusing on ED risks with problem solving, introducing CFT and compassionate interventions imagery with distress tolerance skills, and relapse prevention. Compassion was brought in as a focus in session 7 out of 20 [43]

What are the key findings regarding the effectiveness of Compassion Focused Treatment in addressing body image dissatisfaction within eating disorder populations, considering the role of stigma?

The role of stigma exacerbates body image dissatisfaction and a drive for thinness, which can be an initial con for patients when deciding to commit to compassion-focused treatment. AN patients particularly worry how self-compassion may cause them to give up their efforts to conform to society’s ‘thin ideal’, despite perceived benefits in having more of a sense of self [47]

Individuals who build a more compassionate self-to-self relationship show lower levels of body image dissatisfaction and reduced engagement in eating disorder behaviours [42−46, 48, 49]

Individuals who have taken part in CFT treatment show reductions in internal shame, external shame and self-criticism, with an increase in self-compassion, impacting upon symptoms of eating disorder psychopathology [43, 49]. Further research is needed to understand these links to the role of the shame-symptom cycle maintaining ED pathology

Self-compassion as a mediating factor in the relationship between external shame and drive for thinness, acting as a buffer against the effects of stigma – a potential use of compassion to help with feelings of inferiority and drive for thinness

Those who experience larger decreases in their levels of shame and greater increases in their level of self-compassion in the first 4 weeks of treatment show faster decreases in their eating disorder symptoms over 12-weeks of treatment. Findings were found in a mixed sample of eating disorders (AN-R, AN-BP, BN, EDNOS – BED) [43]

Participants who have a relatively low baseline fear of self-compassion had the greatest improvements in ED pathology and depressive symptoms when in self-compassion treatment [43]