Volume 52, Issue 2 p. 199-214
Original Article

Exploring change processes in compassion focused therapy in psychosis: Results of a feasibility randomized controlled trial

Christine Braehler

Corresponding Author

Christine Braehler

NHS Ayrshire & Arran, UK

University of Glasgow, UK

Correspondence should be addressed to Dr Christine Braehler, Praxisgemeinschaft für Psychotherapie, OberföhringerStraße 18, München 81679, Germany (e-mail: [email protected]).Search for more papers by this author
Andrew Gumley

Andrew Gumley

NHS Ayrshire & Arran, UK

University of Glasgow, UK

Search for more papers by this author
Janice Harper

Janice Harper

NHS Ayrshire & Arran, UK

Search for more papers by this author
Sonia Wallace

Sonia Wallace

NHS Ayrshire & Arran, UK

University of Glasgow, UK

Search for more papers by this author
John Norrie

John Norrie

University of Aberdeen, UK

Search for more papers by this author
Paul Gilbert

Paul Gilbert

University of Derby, UK

Search for more papers by this author
First published: 24 October 2012
Citations: 201

First author acted as Chief Investigator, trial therapist, and contributed as the main author of the manuscript. The second author acted as co-investigator and contributed to the write-up of manuscript. The third author acted as co-investigator and trial therapist. The fourth author acted as research assistant for the study involving recruiting participants, collecting and entering data. The fifth author provided statistical consultation required for the revisions of the manuscript. The sixth author is the founder of the therapeutic approach and acted as advisor to trial therapists and contributed to the write-up of the manuscript.

Abstract

Objectives

Compassion focused therapy (CFT) was developed to stimulate capacities for soothing and affiliation to self and others as a way to regulate the threat system. This feasibility study aimed to assess the safety, the acceptability, the potential benefits, and associated change processes of using group CFT with people recovering from psychosis.

Design

A prospective, randomized, open-label, blinded end point evaluation design was used.

Method

Forty adult patients with a schizophrenia-spectrum disorder were randomized to CFT plus treatment as usual (TAU; n = 22) or to TAU alone (n = 18). Group CFT comprised 16 sessions (2 hr each, 1 x week). Participants were assessed prior to randomization and at the end of treatment. Assessments included semi-structured interviews to elicit narratives of recovery from psychosis and self-report measures. At the end of treatment, participants were rated on the Clinical Global Impression Scale. Narratives were coded using the Narrative Recovery Style Scale to provide measures of change in compassion and avoidance. Change processes were correlated with changes in depression, personal beliefs about illness, fear of recurrence, and positive and negative affect.

Results

Group CFT was associated with no adverse events, low attrition (18%), and high acceptability. Relative to TAU, CFT was associated with greater observed clinical improvement (p < 0.001) and significant increases in compassion (p = 0.015) of large magnitude. Relative to TAU, increases in compassion in the CFT group were significantly associated with reductions in depression (p = 0.001) and in perceived social marginalization (p = 0.002).

Discussion

Findings support the feasibility of group CFT in psychosis and suggest that changes in compassion can be achieved, which appear to reduce depression in particular. This is the first randomized controlled evaluation of CFT.

Conclusion

Compassion focused therapy appears as a safe, acceptable, promising, and evolving intervention for promoting emotional recovery from psychosis.

Practitioner Points

  • Compassion focused therapy appears safe to use with people recovering from psychosis.
  • Compassion focused therapy was associated with significantly greater clinical improvement than Treatment as Usual.
  • Relative to TAU, CFT was associated with a significant increase in compassion of large magnitude.
  • Relative to TAU, in the CFT group increases in compassion were significantly associated with reductions in depression and in perceived social marginalization.