Mind compassion: Mental health outcomes and change processes in Compassion Focused Therapy

Over the past three decades, two movements became apparent in the field of psychotherapy: (1) a movement towards therapies targeting processes of mindfulness, acceptance and compassion, and (2) a movement towards therapies wherein well-being is an important outcome. The overarching aim of this thesis was to add to the scientific evidence base underlying a rapidly emerging psychotherapeutic intervention that suits both developments: Compassion Focused Therapy (CFT). CFT aims to build a compassionate mind which encompasses the capacity to notice, tolerate and empathize with suffering of self and others as well as the commitment to tackle or mitigate (the impact of) suffering through directing one’s attention towards resources for care, generating soothing thoughts and feelings, and performing caring behaviours. At the heart of this thesis, lies a large-scale waitlisted randomised controlled trial (RCT) conducted so as to test whether CFT offered as guided self-help is effective in improving mental health in adults with low to moderate levels of well-being. Findings from the RCT indicate that CFT is a feasible, acceptable and effective form of intervention, not only for relieving psychological distress but also for improving well-being. Based on the outcomes of closely related interventions, utilising online delivery formats is deemed a promising strategy for reaching the full potential of CFT as a scalable public mental health strategy. CFT was found to impact mental health through multiple pathways, namely through cultivating self-reassurance, reducing self-criticism and regulating positive and negative affect. For enhancing well-being, cultivating self-reassurance seems to be the central mechanism of change, and more specifically the ability to experience compassionate feelings and/or sensations. The Forms of Self-Criticising/Attacking and Self-Reassuring Scale (FSCRS) offers a valid and reliable instrument for measuring two major processes of change in CFT, namely building self-reassurance and reducing self-criticism. To advance research on change processes in CFT, a short form of the FSCRS was created suited to large-scale trials with multiple assessment times. Taken altogether, despite that CFT is still a fairly young area of research, this thesis provides promising evidence for the effectiveness of CFT and preliminary evidence for multiple theory-driven processes of change