An exploration of self-compassion and psychosis

Abstract

Section A
Background: Theories suggest that psychotic experiences exist along a continuum between clinical and non-clinical populations. Self-criticism appears to be related to psychotic experiences. Low self-compassion appears to be associated with self-criticism and psychotic experiences. It is currently unclear how self-criticism and self-compassion may relate to psychotic experiences in both clinical and non-clinical populations.

Aims: To conduct a systematic review of the relationship between self-criticism, self-compassion and psychotic experiences (frequency, severity, endorsement and distress) in clinical and non-clinical populations.

Method: A systematic search of MEDLINE (Ovid), Embase (Ovid), and APA Psycinfo (Ovid) was conducted. Studies were selected according to the inclusion criteria. A quality assessment of eligible studies was conducted.

Results: A narrative synthesis of 17 empirical, quantitative studies revealed high-quality evidence supporting links between self-compassion, self-criticism and a range of psychotic experiences (overall positive and negative symptoms, hallucinations, delusions and paranoia).
Self-criticism appeared most strongly linked to distress associated with psychotic experiences. Longitudinal studies could provide further insight into the role of self-criticism and self-compassion in the development of psychosis.

Conclusions: Findings indicate self-criticism is a risk factor for distressing psychotic experiences, and that self-compassion may be a protective factor, supporting the use of therapies such as Compassion Focused Therapy.

Section B
Background: Given current access issues of psychological therapies for psychosis, it is prudent to explore waiting list and group interventions which might be more efficient. There is some evidence for the efficacy of group compassion focused therapy (CFTgp) for psychosis, but a lack of clarity regarding who might benefit and when.

Aims: This study aimed to understanding therapeutic change processes of CFTgp, and how these relate to group timing and service user experiences of recovery.

Methodology: A critical realist, grounded theory methodology was used. One-to-one interviews were conducted with 6 service users and 4 therapists who had taken part in CFTgp. Participants were recruited from two NHS psychosis community services.

Results: ‘Social safeness’ and ‘changes in self-compassion and self-understanding’ captured the two key change processes in CFTgp. Changes during CFTgp were enhanced by ‘Managing hurdles and barriers’. ‘Rebuilding, reclaiming and reintegrating’ captured experiences of recovery after CFTgp. ‘Readiness’ captured how prior experiences may enhance or diminish therapeutic change. Clinical, theoretical and research implications are discussed.

Conclusions: The model adds to the current literature on change processes of CFTgp, and how changes can be integrated into recovery journeys. Further research is needed to clarify factors inhibiting engagement or therapeutic change.

Date of Award	2025
Original language	English