A systematic review of the effectiveness of compassion focused imagery in improving psychological outcomes in clinical and non-clinical adult populations.

Abstract

Compassion-focused imagery (CFI) is a technique used to facilitate self-compassion by constructing and exploring imagery of a compassionate ideal. It is commonly used in Compassionate Mind Training, as part of a wider skills training intervention. This review aimed to explore the effectiveness of CFI on psychological outcomes when used as a brief standalone intervention across clinical and non-clinical adult populations. Population-specific effects were also explored. Following an extensive literature search, 20 studies were identified for inclusion in the review. Quality and risk of bias assessment were completed using the Effective Public Health Practice Project (EPHPP) tool. Where available, effect sizes were calculated for outcome measures of self-compassion, self-criticism and shame. Study findings were qualitatively synthesized. Most of the studies reported improvements in psychological outcomes, such as improvements in self-compassion and positive affect, reduction in self-criticism, shame and paranoia. Across measures of self-compassion, self-criticism and shame, the effect sizes ranged between 0.02 and 1.1 and estimated treatment effects range between 0.09 and 1.39. Preliminary evidence is promising, with most studies reporting improvements in psychological outcomes; however, the evidence is limited by the methodological challenges and heterogeneity within the literature. Studies that implemented CFI in severe head injury samples reported limited improvements. Improvements in paranoia measures were more consistently reported in non-clinical samples, when compared to studies using clinical samples. High levels of self-criticism emerged as an important potential barrier in individuals' ability to engage with CFI tasks.