The Effectiveness of Compassion Focused Therapy for the Three Flows of Compassion, Self-Criticism, and Shame in Clinical Populations: A Systematic Review

Compassion Focused therapy (CFT) is designed to reduce shame (internal and external) and self-criticism while enhancing the three flows of compassion (compassion to others, from others, and for the self). This systematic review evaluated the effectiveness of CFT on these core theoretical constructs in adult clinical populations. A systematic search of three databases (2000–2024) identified 21 studies (N = 450) meeting the inclusion criteria. The studies were narratively synthesised, and quality was assessed using the EPHPP tool. Consistent improvements in self-compassion (g = 0.23–4.14) and reductions in self-criticism (g = 0.29–1.56) were reported. Reductions in external shame were also observed (g = 0.54–1.22), though this outcome was examined in fewer studies. Limited and inconsistent evidence was found for internal shame and interpersonal compassion flows (compassion to and from others), with only a small number of low- to moderate-quality studies addressing these outcomes. Follow-up effects were rarely assessed, and comparator groups were limited. Most interventions were group-based and of variable methodological quality, with frequent selection bias, small sample sizes, and limited demographic diversity. Overall, CFT shows promise for targeting self-directed processes in clinical populations, though stronger evidence is needed to understand its effects on relational components of compassion. Future research should adopt standardised measures, improve methodological rigour, and recruit more diverse samples.