The use and outcomes of compassion-focused group interventions with children and adolescents in diverse service settings: a systematic review and narrative synthesis and Adaptation of the Fears of Compassion (Kindness) Scale for use with individuals with an intellectual disability (FCS-ID): A Delphi study

Roberts, Georgia 2025. The use and outcomes of compassion-focused group interventions with children and adolescents in diverse service settings: a systematic review and narrative synthesis and Adaptation of the Fears of Compassion (Kindness) Scale for use with individuals with an intellectual disability (FCS-ID): A Delphi study. ClinPsy Thesis, Cardiff University. Item availability restricted.

	PDF (DClinPsy Thesis) - Accepted Post-Print Version Restricted to Repository staff only until 27 October 2026 due to copyright restrictions. Download (8MB)
	PDF (Publication Form) - Supplemental Material Restricted to Repository staff only Download (99kB)

Abstract

This thesis presents two papers exploring topics related to compassion-focused therapy (CFT). Compassion is defined as a sensitivity to suffering in oneself and others, coupled with a commitment to alleviate and prevent it. CFT conceptualises compassion flowing in three relational directions: compassion towards ourselves, compassion towards others, and receiving compassion from others. CFT aims to reduce difficulties related to mood, shame, and self-criticism while enhancing experiences of compassion. CFT is delivered in individual and group formats and has been applied across adult, child, and adolescent populations. Research indicates that many individuals, including within these populations, experience ‘fears’ or ‘blocks’ when developing and/or expressing compassion, highlighting the importance of addressing these barriers in therapeutic work. Several outcome measures which assess compassion exist. One widely used measure is the Fears of Compassion Scale, which assesses blocks to compassion across the three flows. However, most compassion-focused measures have been developed and validated with ‘neurotypical’ adults. Adaptation and validation for specific populations, such as individuals with intellectual disabilities, children, and adolescents, is essential but currently lacking. In research with people with intellectual disabilities, authors often informally adapt existing measures. In studies with younger populations, measures developed for adults are used. The two papers presented in this thesis are closely connected by their shared focus on the application of CFT, and the measurement of compassion-focused outcomes in under-researched populations. Paper One is a systematic review investigating the use and effectiveness of CFT group interventions for child and adolescent clinical populations. While this is an emerging area of research, literature suggests that CFT may be particularly relevant for younger people. During adolescence, social motivational systems are developing, which can increase sensitivity to peer acceptance and social belonging. Many young people also experience difficulties related to attachment relationships, bullying, and other forms of rejection, which can lead to self-criticism and shame – key targets of CFT. One review which examined third-wave therapies for this population included two CFT studies, and highlighted group interventions as the most common delivery format. However, the review combined outcomes, making it challenging to isolate the effects of CFT. Therefore, the current review aimed to use a narrative synthesis approach to evaluate the methodological quality of research, alongside examining compassion and mental health outcomes. Following a systematic search and screening of 1090 studies, nine studies were identified, including 171 participants aged between 11-17 years. This review found some evidence that CFT group interventions may increase self-compassion and improve the wellbeing of children and adolescents, although outcomes were mixed. Methodological limitations made it challenging to draw conclusions about the effectiveness of group interventions. This study has important implications for future research, highlighting the need for development and validation of developmentally appropriate outcome measures tailored for younger populations. Without reliable and valid measures to assess clinical change, practitioners may struggle to examine therapeutic progress and consequently the impact of CFT in practice. Furthermore, the findings hold promise that CFT can be an effective therapeutic option for some young people. However, more evidence with improved research designs is required to better inform clinical practice and guidelines. Paper Two adapted the Fears of Compassion Scale for use with individuals with intellectual disabilities. The original measure contains complex language and abstract concepts that may be difficult for many individuals with intellectual disabilities to understand. The adaptation process followed three key stages. First, the research team modified the language of each item to make it more accessible for consultation. Next, a focus group was held with three individuals with intellectual disabilities to explore how they understood the items and evaluate the clarity and accessibility of the language/concepts used. Finally, a Delphi method was used to gather the views of professionals with expertise in both CFT and intellectual disabilities. The Delphi process involved a series of three anonymous questionnaire rounds to reach group consensus on which items should be retained, removed, or adapted. Twelve professionals participated, reaching agreement on initial candidate items for the adapted measure. This study is the first of its kind to co-produce a compassion-focused measure specifically for individuals with intellectual disabilities. The resulting 10-item version of the Fears of Compassion Scale represents a promising step in developing appropriate measures to use in psychological therapy with this population. While further work is required to assess the psychometric properties of this measure across different contexts, this study offers important clinical implications. Once validated, this measure may enhance therapeutic engagement, with the adapted questions being more meaningful and accessible to individuals with intellectual disabilities. Furthermore, practitioners may gain greater confidence that the measure is assessing what it is intended to, such as fears and openness to compassion across the three flows. This, in turn, could improve the reliability of this evidence base, as the efficacy of CFT for this under-researched population needs to be better assessed.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	27 October 2025
Last Modified:	28 Oct 2025 11:22
URI:	https://orca.cardiff.ac.uk/id/eprint/181897

Actions (repository staff only)

Edit Item