[What do we know about compassion focused therapy for anxiety and depressive symptoms: A scoping review].

Résumé

OBJECTIVE: Anxiety and depressive disorders are among the most common psychiatric conditions and have a high comorbidity rate. While cognitive behavioral therapy (CBT) remains the gold standard psychotherapeutic treatment, its protocols which focus on a specific disorder have limitations when faced with clinical complexity. Transdiagnostic approaches aim to overcome these constraints by targeting processes common to different mental disorders. Compassion-Focused Therapy (CFT) is part of this approach. It is particularly aimed at patients with overwhelming shame and marked self-criticism, often linked to early adverse experiences and associated with resistance to treatment. Drawing on evolutionary psychology, attachment theory, and affective neuroscience, CFT seeks to restore the ability to self-soothe and cultivate self-compassion, which can reduce anxiety and depressive symptoms, among other benefits. This scoping review aims to synthesize the available data on the effectiveness of CFT in the treatment of anxiety and depressive disorders.METHOD: A scoping review was conducted using the PsycINFO, PubMed, CINAHL, Web of Science, and Google Scholar search engines, as well as gray literature to include unpublished studies, so as to systematically identify articles published between 1984 and 2024 on the effect of CFT on anxiety and depressive symptoms in adults.RESULTS: The included studies were highly heterogeneous in terms of methodology. The majority reported a significant reduction in anxiety (n=11), depression (n=14), and anxiety-depressive symptoms (n=30) after the intervention, while others showed no significant difference in anxiety (n=7), depression (n=2), or anxiety-depressive symptoms (n=3) compared to control groups (waiting list, usual treatment, other therapies). Participants came from a variety of populations: psychiatric patients (mood disorders, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, psychotic disorder, personality disorder, bulimia, dementia) (51 %, n=32), non-clinical samples (students, parents, teachers, the general public) (31 %, n=20), or subjects with somatic conditions (irritable bowel syndrome, cancer, pain, chronic illness, acne, multiple sclerosis, cardiovascular disease) (14 %, n=9). CFT, most often delivered in groups (n=44, 70 %) of 8 to 12 sessions (n=22), generally lasting 90 to 120minutes (n=26), mainly incorporated compassionate imagery techniques (n=39), development of a compassionate self (n=37), and mindfulness practices (n=36). Self-compassion was the most frequently identified mechanism of action (n=21). Other mechanisms explored included self-criticism (n=14), self-reassurance (n=11), fears related to self-compassion (n=8), fear of compassion towards others (n=5), ability to receive compassion from others (n=5), ability to offer compassion to others (n=5), rumination (n=3), comparison between oneself and others (n=3), and physiological factors such as heart rate variability (n=2). These results suggest that CFT may exert its effects by promoting a more compassionate and accepting relationship with oneself and others, reducing self-criticism, and improving emotional regulation.CONCLUSION: CFT appears to be a promising approach for reducing anxiety and depression symptoms. However, the heterogeneity of the studies and the lack of randomized controlled trials limit the scope of the conclusions. Additional rigorously designed research is needed to confirm its effectiveness, clarify the conditions under which it is most effective, and specify its mechanisms of action.