Pathways to improving mental health in Compassion-Focused Therapy: Self-reassurance, self-criticism and affect as mediators of change

Objective: The working mechanisms of compassion-focused therapy (CFT) remain understudied. Drawing on the theoretical model underlying CFT, we examined four putative working mechanisms – self-reassurance, self-criticism, positive/negative affect – in relation to changes in well-being and psychological distress. Methods: Data of a waitlist randomised controlled trial (N = 242) investigating the effectiveness of a self-help CFT-intervention in a non-clinical sample were analysed. Using single and multiple mediation models, we assessed if changes in self-reassurance, self-criticism and positive/negative affect during the intervention (3-month interval) mediated changes in well-being and depressive/anxiety symptoms from baseline to follow-up (6-month interval) compared to the waitlist condition. Results: For each outcome, single analyses revealed that the effects of CFT were significantly mediated by self-reassurance and self-criticism. The mediating role of affect differed across outcomes. In combined models, self-reassurance emerged as a significant mediator for well-being and anxiety symptoms. Additionally, positive and negative affect were found significant mediators of the effects on depressive and anxiety symptoms, respectively. Conclusion: This study provides preliminary empirical evidence that CFT operates through cultivating self-reassurance, reducing self-criticism and regulating positive and negative affect in a non-clinical sample. To advance the development of CFT, further exploration of therapeutic change processes and their interplay is needed.