An exploration of Compassion Focused Imagery (CFI) in women with sub-clinical eating disorder symptoms

  • Zoe-Lydia Tsivos

Student thesis: Doctor of Clinical Psychology


Compassion Focused Therapy (CFT) is an emerging transdiagnostic treatment which aims to attenuate common psychological problems including shame and self-criticism through building compassionate skills. These problems are considered relevant and implicated in the maintenance of eating disorders. Imagery in particular has attracted attention as an important treatment technique for its strong links with memory. The aim of this thesis was to explore the effect of Compassion Focused Imagery (CFI) in women with sub-clinical eating disorder symptoms. Paper 1 is a systematic review of the CFT literature across disorders and in transdiagnostic groups. The main aims of the review were to evaluate the literature, synthesise the content of CFT across studies and provide preliminary effect size calculations. Eighteen articles were identified including clinical and non-clinical, treatment and experimental studies. The current body of evidence includes transdiagnostic samples, eating disorders, psychosis, acquired brain injury, depression, posttraumatic stress disorder (PTSD), personality disorder, individuals high in self-criticism and those with acne. The review includes a synthesis of intervention content, modalities, training and supervision of CFT within the literature. Strongest evidence was identified within transdiagnostic groups with more limited evidence for CFT within PTSD, personality disorders, acne sufferers and high self-critics. Effect sizes varied from 0-0.9 across shame, self-criticism and self-compassion outcomes. The area is limited by few controlled evaluations and heterogeneous content of interventions. Paper 2 is an experimental study of the effect on CFI in an analogue (sub-clinical) sample of women with elevated levels of eating disorder symptoms. Following baseline assessments measuring shame, self-criticism, self-compassion and stress, anxiety and depression, women with global scores of 2.5 or over on the Eating Disorders Examination Questionnaire (EDE-Q) were randomly allocated to either CFI condition in which they were instructed to create an image of a compassionate other or to a neutral imagery condition which involved creating an image of a neutral object. A third group of individuals with global scores of 1.0 or less on the EDE-Q were recruited for comparison only. Following a practice period of five-to-seven days, participants were assessed a final time. Controlling for baseline scores, significantly greater reductions in shame were reported in the CFI group compared with the neutral imagery group. Increases in self-compassion and decreases in self-criticism and depression, anxiety and stress were favourable in the CFI group compared with those in the neutral imagery group; however, these findings did not reach statistical significance. Compassion focused imagery appeared to be well tolerated within the CFI group. Clinical and theoretical implications and future research directions are discussed. The third chapter offers a reflective discussion on the methodological strengths and weaknesses, clinical and theoretical implications beginning with the systematic review followed by the empirical paper. Chapter 3 concludes with a final section on personal and professional reflections throughout the research process.
Date of Award31 Dec 2015
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorJohn Fox (Supervisor) & Anja Wittkowski (Supervisor)


  • compassion focused imagery
  • eating disorders
  • compassion focused therapy

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