{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:55:30Z","timestamp":1783655730431,"version":"3.55.0"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n \n Severe obesity (defined as a BMI\u2009\u2265\u200940 kg m\n -2<\/jats:sup>\n ) is often accompanied by significant mental health co-morbidities such as eating disorders and depressive disorder and people living with severe obesity often experience feelings of shame, self-criticism and feelings of inferiority in relation to others. Compassion Focused Therapy (CFT) was specifically designed for people with high levels of shame and self-criticism and aims to promote self-compassion which is regarded as an adaptive emotional regulation strategy.\n <\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n To explore the effect on psychological outcomes of a 10-session (weekly for 2 hours) in-person, group-based CFT intervention for people living with severe obesity. We sought to determine whether CFT would lead to improved self-compassion, depressive symptoms, emotional eating, shame, self-criticism, submissive behavior, and negative social comparison.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n A single-centre, randomized controlled trial was carried out with 91 participants allocated to either \u2018treatment as usual\u2019 (n\u2009=\u200946) or \u2018treatment as usual with additional group based CFT\u2019 (n\u2009=\u200945). Treatment as usual included dietary advice, assessment by a Consultant Endocrinologist with possible prescription of medication, and participation in an eight-week lifestyle modification programme. Psychological outcomes were recorded at three time points (pre-treatment, post-treatment, and three-months after the end of group-based CFT).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n CFT led to statistically and clinically significant improvements in self-compassion, self-coldness, mood, shame, emotional eating, self-criticism, social comparison, and submissive behaviour (all\n p<\/jats:italic>\n \u2009<\u20090.001) compared with treatment as usual. These results were maintained at three-month follow-up.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Group CFT appears to be an effective psychological intervention to alleviate psychological distress in people living with severe obesity.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n ClinicalTrials.gov\n NCT03249441<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0342744","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:21:43Z","timestamp":1774459303000},"page":"e0342744","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Compassion-focused group therapy improves depression, emotional eating, self-criticism and shame in people living with severe obesity: A single-centre, examiner-blind randomized controlled trial"],"prefix":"10.1371","volume":"21","author":[{"given":"Mary","family":"Hynes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis M.","family":"Finucane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"O\u2019Brien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"McAnena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"O\u2019Shea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0610-0593","authenticated-orcid":true,"given":"Monika","family":"Pilch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-6639","authenticated-orcid":true,"given":"Brian E.","family":"McGuire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"pone.0342744.ref001","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jad.2011.03.025","article-title":"Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews","volume":"133","author":"M de Zwaan","year":"2011","journal-title":"J Affect Disord"},{"issue":"10","key":"pone.0342744.ref002","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1177\/1359105319890019","article-title":"Effect of adding a compassion-focused intervention on emotion, eating and weight outcomes in a commercial weight management programme","volume":"26","author":"C Duarte","year":"2021","journal-title":"J Health Psychol"},{"issue":"7","key":"pone.0342744.ref003","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1038\/s41366-021-00814-5","article-title":"Weight stigma and health behaviors: evidence from the Eating in America Study","volume":"45","author":"KM Lee","year":"2021","journal-title":"Int J Obes (Lond)"},{"issue":"11","key":"pone.0342744.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0260075","article-title":"A qualitative exploration of obesity bias and stigma in Irish healthcare; the patients\u2019 voice","volume":"16","author":"G O\u2019Donoghue","year":"2021","journal-title":"PLoS One"},{"key":"pone.0342744.ref005","doi-asserted-by":"crossref","first-page":"105257","DOI":"10.1016\/j.appet.2021.105257","article-title":"Examining the relationship between weight controllability beliefs and eating behaviors: the role of internalized weight stigma and BMI","volume":"164","author":"MA Reinka","year":"2021","journal-title":"Appetite"},{"issue":"2","key":"pone.0342744.ref006","article-title":"Investigating the effect of an online self-compassion for weight management (SC4WM) intervention on self-compassion, eating behaviour, physical activity and body weight in adults seeking to manage weight: protocol for a randomised controlled trial","volume":"12","author":"JM Brenton-Peters","year":"2022","journal-title":"BMJ Open"},{"issue":"4","key":"pone.0342744.ref007","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.eatbeh.2014.08.025","article-title":"Escaping from body image shame and harsh self-criticism: exploration of underlying mechanisms of binge eating","volume":"15","author":"C Duarte","year":"2014","journal-title":"Eat Behav"},{"issue":"6","key":"pone.0342744.ref008","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1002\/cpp.1925","article-title":"Body image as a source of shame: a new measure for the assessment of the multifaceted nature of body image shame","volume":"22","author":"C Duarte","year":"2015","journal-title":"Clin Psychol Psychother"},{"key":"pone.0342744.ref009","doi-asserted-by":"crossref","DOI":"10.1002\/9781118328910","volume-title":"Eating and its disorders","author":"J Fox","year":"2012"},{"issue":"2","key":"pone.0342744.ref010","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD003818.pub2","article-title":"Psychological interventions for overweight or obesity","author":"K Shaw","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"pone.0342744.ref011","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s40519-016-0336-y","article-title":"Group cognitive-behavioral treatment for internalized weight stigma: a pilot study","volume":"23","author":"RL Pearl","year":"2018","journal-title":"Eat Weight Disord"},{"key":"pone.0342744.ref012","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.brat.2014.05.006","article-title":"Self-compassion as an emotion regulation strategy in major depressive disorder","volume":"58","author":"A Diedrich","year":"2014","journal-title":"Behav Res Ther"},{"issue":"3","key":"pone.0342744.ref013","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1002\/cpp.2695","article-title":"The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: a systematic review","volume":"29","author":"I Iturbe","year":"2022","journal-title":"Clin Psychol Psychother"},{"issue":"3","key":"pone.0342744.ref014","first-page":"1","article-title":"The effectiveness of mindfulness-based eating awareness training (MB-EAT) on perceived stress and body mass index in overweight women","volume":"6","author":"M Oraki","year":"2019","journal-title":"Int J Appl Behav Sci"},{"issue":"2","key":"pone.0342744.ref015","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s12671-017-0804-0","article-title":"A systematic review of the efficacy of interventions that aim to increase self-compassion on nutrition habits, eating behaviours, body weight and body image","volume":"9","author":"H Rahimi-Ardabili","year":"2017","journal-title":"Mindfulness"},{"issue":"2","key":"pone.0342744.ref016","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1521\/ijct.2010.3.2.97","article-title":"An Introduction to compassion focused therapy in cognitive behavior therapy","volume":"3","author":"P Gilbert","year":"2010","journal-title":"Int J Cogn Ther"},{"issue":"6","key":"pone.0342744.ref017","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1002\/erv.858","article-title":"Shame in women with a history of eating disorders","volume":"16","author":"NA Troop","year":"2008","journal-title":"Eur Eat Disord Rev"},{"issue":"5","key":"pone.0342744.ref018","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1002\/erv.2160","article-title":"General shame and bodily shame in eating disorders: a 2.5-year longitudinal study","volume":"20","author":"NA Troop","year":"2012","journal-title":"Eur Eat Disord Rev"},{"issue":"2","key":"pone.0342744.ref019","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/bjc.12006","article-title":"Why self-critical patients present with more severe eating disorder pathology: the mediating role of shame","volume":"52","author":"AC Kelly","year":"2013","journal-title":"Br J Clin Psychol"},{"issue":"1","key":"pone.0342744.ref020","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1080\/08870446.2021.1955118","article-title":"A systematic review of compassion-based interventions for individuals struggling with body weight shame","volume":"38","author":"A Carter","year":"2023","journal-title":"Psychol Health"},{"issue":"5","key":"pone.0342744.ref021","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1159\/000438681","article-title":"Self-compassion as a resource in the self-stigma process of overweight and obese individuals","volume":"8","author":"A Hilbert","year":"2015","journal-title":"Obes Facts"},{"issue":"1","key":"pone.0342744.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40639-014-0009-5","article-title":"A qualitative study of the understanding and use of \u2018compassion focused coping strategies\u2019 in people who suffer from serious weight difficulties","volume":"1","author":"J Gilbert","year":"2014","journal-title":"J Compassionate Health Care"},{"issue":"1","key":"pone.0342744.ref023","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/bjc.12043","article-title":"The origins and nature of compassion focused therapy","volume":"53","author":"P Gilbert","year":"2014","journal-title":"Br J Clin Psychol"},{"key":"pone.0342744.ref024","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4324\/9780203003459-15","article-title":"Focused therapies and compassionate mind training for shame and self attacking.","volume-title":"Compassion, Conceptualisation, research and use in psychotherapy","author":"P Gilbert","year":"2005"},{"issue":"3","key":"pone.0342744.ref025","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1192\/apt.bp.107.005264","article-title":"Introducing compassion-focused therapy","volume":"15","author":"P Gilbert","year":"2009","journal-title":"Adv psychiatr treat"},{"issue":"6","key":"pone.0342744.ref026","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1002\/cpp.507","article-title":"Compassionate mind training for people with high shame and self\u2010criticism: overview and pilot study of a group therapy approach","volume":"13","author":"P Gilbert","year":"2006","journal-title":"Clin Psychol Psychother"},{"key":"pone.0342744.ref027","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.eatbeh.2017.01.006","article-title":"Finding the link between internalized weight-stigma and binge eating behaviors in Portuguese adult women with overweight and obesity: the mediator role of self-criticism and self-reassurance","volume":"26","author":"L Palmeira","year":"2017","journal-title":"Eat Behav"},{"key":"pone.0342744.ref028","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1037\/10458-016","article-title":"Perfectionism in the therapeutic process.","volume-title":"Perfectionism: theory, research, and treatment","author":"SJ Blatt","year":"2002"},{"key":"pone.0342744.ref029","doi-asserted-by":"crossref","first-page":"586161","DOI":"10.3389\/fpsyg.2020.586161","article-title":"Compassion: from its evolution to a psychotherapy","volume":"11","author":"P Gilbert","year":"2020","journal-title":"Front Psychol"},{"issue":"4","key":"pone.0342744.ref030","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.bodyim.2014.07.005","article-title":"Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility","volume":"11","author":"AC Kelly","year":"2014","journal-title":"Body Image"},{"issue":"1","key":"pone.0342744.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0167571","article-title":"The impact of shame, self-criticism and social rank on eating behaviours in overweight and obese women participating in a weight management programme","volume":"12","author":"C Duarte","year":"2017","journal-title":"PLoS One"},{"issue":"3","key":"pone.0342744.ref032","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1080\/10503307.2012.717310","article-title":"Self-compassion and fear of self-compassion interact to predict response to eating disorders treatment: a preliminary investigation","volume":"23","author":"AC Kelly","year":"2013","journal-title":"Psychother Res"},{"issue":"4","key":"pone.0342744.ref033","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1080\/14737175.2020.1746184","article-title":"Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations","volume":"20","author":"C Craig","year":"2020","journal-title":"Expert Rev Neurother"},{"issue":"2","key":"pone.0342744.ref034","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1037\/cps0000193","article-title":"The impact of compassion-focused therapy on positive and negative mental health outcomes: results of a series of meta-analyses","volume":"31","author":"N Petrocchi","year":"2024","journal-title":"Clin Psychol Sci Pract"},{"issue":"1","key":"pone.0342744.ref035","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s10826-018-1239-5","article-title":"Associations between mindfulness, self-compassion, difficulties in emotion regulation, and emotional eating among adolescents with overweight\/obesity","volume":"28","author":"MJ Gouveia","year":"2018","journal-title":"J Child Fam Stud"},{"issue":"4","key":"pone.0342744.ref036","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1177\/02601060221094671","article-title":"Exploring the association between self-compassion, mindfulness and mindful eating with eating behaviours amongst patients with obesity","volume":"29","author":"M Hussain","year":"2023","journal-title":"Nutr Health"},{"issue":"4","key":"pone.0342744.ref037","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1891\/JCPSY-D-20-00015","article-title":"Unburdening the weight of stigma: findings from a compassion-focused group program for women with overweight and obesity","volume":"34","author":"YN Forbes","year":"2020","journal-title":"J Cogn Psychother"},{"issue":"5","key":"pone.0342744.ref038","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.beth.2023.02.001","article-title":"Compassion-focused therapy to reduce body weight shame for individuals with obesity: a randomized controlled trial","volume":"54","author":"A Carter","year":"2023","journal-title":"Behav Ther"},{"key":"pone.0342744.ref039","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12902-015-0038-x","article-title":"Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults","volume":"15","author":"C Crowe","year":"2015","journal-title":"BMC Endocr Disord"},{"key":"pone.0342744.ref040","volume-title":"The compassionate mind approach to beating overeating: using compassion focused therapy","author":"K Goss","year":"2011"},{"issue":"3","key":"pone.0342744.ref041","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/15298860309027","article-title":"The development and validation of a scale to measure self-compassion","volume":"2","author":"KD Neff","year":"2003","journal-title":"Self Identity"},{"issue":"7","key":"pone.0342744.ref042","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1007\/s12671-022-01897-5","article-title":"Embracing the complexity of our inner worlds: understanding the dynamics of self-compassion and self-criticism","volume":"13","author":"M Ferrari","year":"2022","journal-title":"Mindfulness"},{"issue":"6","key":"pone.0342744.ref043","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1037\/cou0000211","article-title":"Two is more valid than one: examining the factor structure of the Self-Compassion Scale (SCS)","volume":"64","author":"RE Brenner","year":"2017","journal-title":"J Couns Psychol"},{"issue":"2","key":"pone.0342744.ref044","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1007\/s12671-017-0803-1","article-title":"An investigation of the factor structure of the self-compassion scale","volume":"9","author":"S Cleare","year":"2018","journal-title":"Mindfulness (N Y)"},{"issue":"3","key":"pone.0342744.ref045","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/0191-8869(95)00086-L","article-title":"A social comparison scale: psychometric properties and relationship to psychopathology","volume":"19","author":"S Allan","year":"1995","journal-title":"Pers Individ Dif"},{"issue":"4","key":"pone.0342744.ref046","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/j.2044-8260.1997.tb01255.x","article-title":"Submissive behaviour and psychopathology","volume":"36","author":"S Allan","year":"1997","journal-title":"Br J Clin Psychol"},{"issue":"5","key":"pone.0342744.ref047","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/0191-8869(94)90149-X","article-title":"An exploration of shame measures\u2014I: the other as Shamer scale","volume":"17","author":"K Goss","year":"1994","journal-title":"Pers Individ Dif"},{"key":"pone.0342744.ref048","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1348\/014466504772812959","article-title":"Criticizing and reassuring oneself: an exploration of forms, styles and reasons in female students","volume":"43","author":"P Gilbert","year":"2004","journal-title":"Br J Clin Psychol"},{"issue":"4","key":"pone.0342744.ref049","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/papt.12049","article-title":"Forms of self-criticising\/attacking & self-reassuring scale: psychometric properties and normative study","volume":"88","author":"R Bai\u00e3o","year":"2015","journal-title":"Psychol Psychother"},{"key":"pone.0342744.ref050","volume-title":"Manual for the beck depression inventory-II","author":"AT Beck","year":"1996"},{"issue":"1","key":"pone.0342744.ref051","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/1098-108X(199507)18:1<79::AID-EAT2260180109>3.0.CO;2-V","article-title":"The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating","volume":"18","author":"B Arnow","year":"1995","journal-title":"Int J Eat Disord"},{"issue":"4","key":"pone.0342744.ref052","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1159\/000509131","article-title":"Greater attendance at a community weight loss programme over the first 12 weeks predicts weight loss at 2 years","volume":"13","author":"C Piernas","year":"2020","journal-title":"Obes Facts"},{"issue":"3","key":"pone.0342744.ref053","doi-asserted-by":"crossref","DOI":"10.1111\/obr.13148","article-title":"Predictors of successful weight loss outcomes amongst individuals with obesity undergoing lifestyle interventions: a systematic review","volume":"22","author":"S Chopra","year":"2021","journal-title":"Obes Rev"},{"issue":"1","key":"pone.0342744.ref054","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s12966-021-01216-6","article-title":"The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial","volume":"18","author":"RA Jones","year":"2021","journal-title":"Int J Behav Nutr Phys Act"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342744","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:21:52Z","timestamp":1774459312000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342744"}},"subtitle":[],"editor":[{"given":"Daisuke","family":"Nagasato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0342744","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]}}}