A Comparison of the Effectiveness of Compassion-Focused Therapy and Mindfulness-Based Cognitive Therapy on Self-Criticism and Intolerance of Uncertainty in Women with Generalized Anxiety Disorder

Document Type : Call for papers in English

Authors

1 Ph.D. Student, Department of Psychology, Ahv.c., Islamic Azad University, Ahvaz, Iran.

2 Associate Professor, Department of Psychology, Ahv.c., Islamic Azad University, Ahvaz, Iran.

3 Assistant Professor, Department of Psychology, Ramh.c., Islamic Azad University, Ramhormoz, Iran.

4 Assistant Professor, Department of Psychology, Ahv.c., Islamic Azad University, Ahvaz, Iran.

10.22055/psy.2026.51429.3541
Abstract
Aim: In women with Generalized Anxiety Disorder (GAD) the combination of high levels of self-criticism and intolerance of uncertainty are factors that impede treatment effectiveness. Both Compassion Focused Therapy and Mindfulness Based Cognitive Therapy have been established as effective methods for treating anxiety disorders and yet limited evidence comparing their relative effects on these two main components- particularly in women with GAD- exist.Most existing studies have assessed only one construct, despite their combined role to maintain anxiety. Therefore, this study aims to compare the effectiveness of Compassion‑Focused Therapy and Mindfulness‑Based Cognitive Therapy in reducing self‑criticism and intolerance of uncertainty among women with Generalized Anxiety Disorder in Ahvaz.
 
Methods: The research method was quasi-experimental with a pretest–posttest design with a control group. The statistical population comprised all women with GAD who sought services at Ahvaz psychological clinics  in 2025. Forty-five women were selected by the purposive sampling and randomly assigned to two experimental groups and one control group (15 participants per group). The research instruments included the Levels of Self-Criticism Scale (Thompson & Zuroff, 2004), and the Intolerance of Uncertainty Scale (Freeston et al., 1994). The experimental groups underwent 10 ninety-minute sessions following the protocols of compassion-focused therapy (Gilbert, 2009) and mindfulness-based cognitive therapy (Segal et al., 2018), while the control group received no intervention.
 
Results: Repeated measures ANOVA results indicated that mean scores of self-criticism components and intolerance of uncertainty in the compassion therapy group and the mindfulness-based cognitive therapy group decreased significantly at posttest and follow-up. Bonferroni follow-up tests also indicated that the effects of the therapies persisted through the follow-up stage (P<.05). For the intolerance of ambiguity, mindfulness-based cognitive therapy was more effective than compassion therapy at posttest and follow-up (P<.05), but no significant difference between the two therapies was observed for self-criticism (P>.05).
 
Conclusion: The results revealed that both treatments yielded persistent improvements in both self-criticism and intolerance of uncertainty; mindfulness based cognitive therapy proved to be more successful at increasing tolerance of uncertainty.Therefore, MBCT may be considered a more efficient approach to reduce the chronic worry and enhancing tolerance of ambiguity in women with GAD.

Keywords


Akbari Klor, S. M., Habibi, M., Ghator, Z., & Azimi Raviz, F. (2019). The effectiveness of group-based compassion therapeutic on uncertainty and concern in female students with generalized anxiety disorder. Women and Culture, 10(40), 54–66. https://journals.iau.ir/article_667225.html?lang=en
Alimehdi, M., & Khosravi, N. (2022). The effectiveness of self-compassion training on anxiety sensitivity, uncertainty intolerance and psychological distress in people with social anxiety. Journal of Clinical Psychology Achievements, 8(1), 1–14. https://doi.org/10.22055/jacp.2023.43478.1289
Alimehdi, M., Ehteshamzadeh, P., Naderi, F., Eftekharsaadi, Z., & Pasha, R. (2016). The effectiveness of mindfulness-based stress reduction on intolerance of uncertainty and anxiety sensitivity among individuals with generalized anxiety disorder. Asian Social Science, 12(4), 179–187. https://doi.org/10.5539/ass.v12n4p179
Asadi, S., Abedini, M., Poursharifi, H., & Nikokar, M. (2017). The relationship between intolerance of uncertainty and rumination with worry on student population. Journal of Clinical Psychology, 4(4), 83–92. https://doi.org/10.22075/jcp.2017.2110
Asadzadeh, N. , makvandi, B. , askari, P. , pasha, R. and naderi, F. (2019). The Effectiveness of Reality Therapy on Social Adjustment, Psychological Well-Being and Self-Criticism of Generalized Anxiety Disorder Referring to Ahvaz Psychological Clinics. Psychological Achievements, 26(2), 159-178. https://doi.org/10.22055/psy.2019.26578.2137
Baharvandi, B., Kazemianmoghadam, K., & Haroon Rashidi, H. (2020). The effectiveness of compassion-focused therapy on ambiguity tolerance and death anxiety in the elderly. Aging Psychology, 6(1), 13–26. https://doi.org/10.22126/jap.2020.5148.1409
Borgdorf, K. S. A., Aguilar-Raab, C., & Holt, D. V. (2025). Effects of a brief online self-compassion training on perfectionism, self-criticism, and social anxiety: A randomized controlled trial. Internet Interventions, 42, 100870. https://doi.org/10.1016/j.invent.2025.100870
Brown, N., & Ashcroft, K. (2025). The effectiveness of compassion focused therapy for the three flows of compassion, self-criticism, and shame in clinical populations: A systematic review. Behavioral Sciences, 15(8), 1031. https://doi.org/10.3390/bs15081031
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40(8), 931–945. https://doi.org/10.1016/S0005-7967(01)00092-4
Canjuga, I., Kozina, G., Mijoč, V., Dretar, E., Breček, A., Novak, V., & Lončarić Kelečić, I. (2025). Self-criticism, self-encouragement and test emotions: A cross-sectional study of Croatian health students. Teaching and Learning in Nursing, 20(3), e736–e744. https://doi.org/10.1016/j.teln.2025.02.015
Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007
Chen, L.-C., Huang, W.-S., Tsai, S.-J., Cheng, C.-M., Chang, W.-H., Bai, Y.-M., Su, T.-P., Chen, T.-J., & Chen, M.-H. (2025). Generalized anxiety disorder, psychiatric comorbidities, and suicide. Social Psychiatry and Psychiatric Epidemiology. Advance online publication. https://doi.org/10.1007/s00127-025-02985-2
Cui, Q., Chen, Y., Tang, Q., Sheng, W., Li, D., Zeng, Y., Jiang, K., He, Z., & Chen, H. (2022). Neural mechanisms of aberrant self-referential processing in patients with generalized anxiety disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 119, 110595. https://doi.org/10.1016/j.pnpbp.2022.110595
De Herrera, J. M., & Turk, C. L. (2025). Impact of a brief self-compassion intervention on state emotion dysregulation in self-reported generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 87, 102012. https://doi.org/10.1016/j.jbtep.2024.102012
Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (2004). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226. https://doi.org/10.1016/S0005-7967(97)00070-3
Dugas, M. J., Sexton, K. A., Hebert, E. A., Bouchard, S., Gouin, J.-P., & Shafran, R. (2022). Behavioral experiments for intolerance of uncertainty: A randomized clinical trial for adults with generalized anxiety disorder. Behavior Therapy, 53(6), 1147–1160. https://doi.org/10.1016/j.beth.2022.05.003
Fatolaahzadeh, N., Majlesi, Z., Mazaheri, Z., Rostami, M., & Navabinejad, S. (2017). The effectiveness of compassion-focused therapy with internalized shame and self-criticism on emotionally abused women. Quarterly Journal of Psychological Students, 13(2), 151–167. https://doi.org/10.22051/psy.2017.12381.1274
Freeston, M. H., Rheaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791–802. https://doi.org/10.1016/0191-8869(94)90048-5
Frostadottir, A. D., & Dorjee, D. (2019). Effects of mindfulness-based cognitive therapy (MBCT) and compassion-focused therapy (CFT) on symptom change, mindfulness, self-compassion, and rumination in clients with depression, anxiety, and stress. Frontiers in Psychology, 10, 1099. https://doi.org/10.3389/fpsyg.2019.01099
Ghafari, Z., Hoseinzadeh, M., & Hashemipour, M. (2025). Compassion-focused therapy effectively reduces self-criticism, negative thoughts, and enhances forgiveness in women post-marital infidelity. PCP, 13(4), 347–354. https://doi.org/10.32598/jpcp.13.4.1069.1
Ghanizadeh Balderloo, K., Moheb, N., Alivandi Vafa, M., & Azemodeh, M. (2025). The effectiveness of mindfulness-based cognitive therapy on cognitive emotion regulation, intolerance of uncertainty and cognitive flexibility in people with generalized anxiety disorder. Research in Clinical Psychology and Counseling, 15(1), 79–96. https://doi.org/10.22067/tpccp.2025.81957.1483
Gilbert, P. (2009). The compassionate mind: Using the power of compassion to understand and alleviate suffering. London, UK: Constable. https://www.amazon.co.uk/Compassionate-Mind-Compassion-Focused-Therapy/dp/1849010986
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043
Halamová, J., Kanovský, M., Jurková, V., & Kupeli, N. (2018). Effect of a short-term online version of a mindfulness-based intervention on self-criticism and self-compassion in a nonclinical sample. Studia Psychologica, 60(4), 259–273. https://doi.org/10.21909/sp.2018.04.766
Hasanzade, F., & Tabatabaii, S. (2019). Relationship shame, Self-compassion and Intolerance of Uncertainty with eating Attitudes in female students. Psychological Achievements, 26(2), 179-198. https://doi.org/10.22055/psy.2019.23975.1920
Hayes-Skelton, S. A., & Lee, C. S. (2020). Decentering in mindfulness and cognitive restructuring for social anxiety: An experimental study of a potential common mechanism. Behavior Modification, 44(6), 817–840. https://doi.org/10.1177/0145445519850744
Hocken, K., & Taylor, J. (2021). Compassion-focused therapy as an intervention for sexual offending. In (pp. 189–219). Routledge. https://doi.org/10.4324/9780429262074-9
Jafari, E., HamidieRad, H., Rasoolzadeh, B., Kordmirza Nikoozadeh, E., & Pourmohseni Koluri, F. (2023). The effectiveness of mindfulness-based cognitive therapy on treatment motivation and self-criticism in substance-dependent individuals. Research on Addiction, 16(66), 91–112. https://doi.org/10.52547/etiadpajohi.16.66.91
Jafarpour, E., Bahadori, A., Zamani Aghmioni, S. E., & Barzegari Soltan Ahmadi, M. (2025). Comparison of the effectiveness of self-compassion-focused therapy and cognitive behavioral therapy on reducing anxiety, depression, and self-criticism in women with generalized anxiety disorder. Quarterly of Experimental and Cognitive Psychology, 2(1), 150–168. https://quarterlyecp.com/index.php/ecp/article/view/185
Jiang, X., Zhang, A., & Zhang, Q. (2025). The effects of mindfulness-based intervention on social anxiety, mindfulness, intolerance of uncertainty and emotion dysregulation: A serial multiple mediating structural equation model. Current Psychology, 44, 2634–2647. https://doi.org/10.1007/s12144-025-05692-1
Keyvan Tabar, S., & Alimehdi, M. (2025). Impact of self-compassion training on the severity of symptoms, anxiety sensitivity, and distress tolerance in women with dermatillomania and trichotillomania. IJPCP, 31(1), 1–22. https://doi.org/10.32598/ijpcp.31.5209.1
Kim, M. K., Lee, K. S., Kim, B., Choi, T. K., & Lee, S.-H. (2016). Impact of mindfulness-based cognitive therapy on intolerance of uncertainty in patients with panic disorder. Psychiatry Investigation, 13(2), 196–202. https://doi.org/10.4306/pi.2016.13.2.196
Krieger, T., Reber, F., von Glutz, B., Urech, A., Moser, C. T., Schulz, A., & Berger, T. (2019). An internet-based compassion-focused intervention for increased self-criticism: A randomized controlled trial. Behavior Therapy, 50(2), 430–445. https://doi.org/10.1016/j.beth.2018.08.003
Lee, J.-T., Lee, Y.-H., & Chang, Y.-P. (2022). Mindfulness stress management for female cancer survivors facing the uncertainty of disease progression: A randomized controlled study. International Journal of Environmental Research and Public Health, 19(8), 4497. https://doi.org/10.3390/ijerph19084497
Li, S. H., Lloyd, A. R., & Graham, B. M. (2021). Subjective sleep quality and characteristics across the menstrual cycle in women with and without generalized anxiety disorder. Journal of Psychosomatic Research, 148, 110570. https://doi.org/10.1016/j.jpsychores.2021.110570
Linardon, J., Moffitt, R., Anderson, C., & Tylka, T. L. (2025). Testing for longitudinal bidirectional associations between self-compassion, self-criticism, and positive body image components. Body Image, 49, 101722. https://doi.org/10.1016/j.bodyim.2024.101722
Ma, C., Smith, T. E., & Culhane, D. P. (2025). Generalized anxiety disorder prevalence and disparities among U.S. adults: The roles played by job loss, food insecurity, and vaccinations during the COVID-19 pandemic. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 80(3), gbae181. https://doi.org/10.1093/geronb/gbae181
Mousavi, A., & Ghorbani, N. (2006). Self-criticism, self-knowledge and mental health. Quarterly Journal of Psychological Studies, 2(3), 75–91. https://doi.org/10.22051/psy.2006.1688
Naeinian, M. R., Shaeiri, M. R., Sharif, M., & Hadian, M. (2011). To study reliability and validity for a brief measure for assessing generalized anxiety disorder (GAD-7). Biannual Journal of Clinical Psychology & Personality, 9(1), 41–50. https://cpap.shahed.ac.ir/article_2647.html
Nasiri, Z., Ahadi, H., Kalhornia Golkar, M., Teymouri, S., & Khadem Ghaebi, N. (2022). Effect of mindfulness-based cognitive therapy on intolerance of uncertainty in infertile women undergoing in vitro fertilization treatment. Journal of Health Research in Community, 7(4), 75–80. http://jhc.mazums.ac.ir/article-1-576-en.html
Ondrejková, N., Halamová, J., & Strnádelová, B. (2022). Effect of the intervention mindfulness-based compassionate living on the level of self-criticism and self-compassion. Current Psychology, 41(5), 2747–2754. https://doi.org/10.1007/s12144-020-00732-3
Papenfuss, I., Lommen, M. J. J., Huisman, M., & Ostafin, B. D. (2022). Aversive response to uncertainty as a mediator for the effect of a mindfulness intervention on symptoms of anxiety. International Journal of Psychophysiology, 178, 1–10. https://doi.org/10.1016/j.ijpsycho.2022.06.014
Parlar Yazici, A. (2024). The effect of mindfulness-based interventions on anxiety disorders through intolerance of uncertainty and resilience [Thesis]. University of Plymouth. https://doi.org/10.24382/5205
Peyambari, M., Mansoobifar, M., Havassi Somar, N., Tari Moradi, A., & Belyad, M. R. (2021). Effectiveness of mindfulness-based cognitive therapy on negative automatic thoughts, self-criticism and rumination in students experiencing emotional failure. NPWJM, 9(32), 6–17. https://doi.org/10.29252/npwjm.9.32.6
Probst, G. H., Gómez Penedo, J. M., & Flückiger, C. (2025). Long-term efficacy of cognitive behavioural therapy for generalized anxiety disorder: A 2–8-year follow-up of two randomized controlled trials. Behaviour Research and Therapy, 191, 104758. https://doi.org/10.1016/j.brat.2025.104758
Riley, J. A., Wilson, E. J., Norton, A. R., & Abbott, M. J. (2025). Exploring the role of early maladaptive schemas and intolerance of uncertainty in generalized anxiety disorder. British Journal of Clinical Psychology. Advance online publication. https://doi.org/10.1111/bjc.70012
Ryan, Z. J., Rayson, H., Morriss, J., & Dodd, H. F. (2025). Does intolerance of uncertainty predict child generalised anxiety? A longitudinal study. Journal of Anxiety Disorders, 112, 103004. https://doi.org/10.1016/j.janxdis.2025.103004
Salartash, V., Azad Yekta, M., & Zabihi, R. (2022). The effectiveness of cognitive behavior therapy on anxiety, physical symptoms, worry, and attention deficit in women with generalized anxiety disorder. The Open Public Health Journal, 15, e2209080. https://doi.org/10.2174/18749445-v15-e2209080
Schaffer, J., Stewart, K., Ovanessian, M., & Zheng, S. (2025). Shame aversion contributes to worry above aversion to other emotions in generalized anxiety disorder. International Journal of Cognitive Behavioral Therapy, 18(2), 301–319. https://doi.org/10.1007/s41811-025-00234-7
Schanche, E., Vøllestad, J., Visted, E., Svendsen, J. L., Binder, P.-E., Osnes, B., Franer, P., & Sørensen, L. (2021). Self-criticism and self-reassurance in individuals with recurrent depression: Effects of mindfulness-based cognitive therapy and relationship to relapse. Counselling and Psychotherapy Research, 21(2), 2747–2754. https://doi.org/10.1002/capr.12381
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2018). Mindfulness-based cognitive therapy for depression (2nd ed.). New York, NY: Guilford Press. https://www.amazon.com/Mindfulness-Based-Cognitive-Therapy-Depression-Second/dp/1462507506
Short, L. B., Xia, R., & O’Brien, W. H. (2025). Post-traumatic stress, cognitive fusion, and intolerance of uncertainty as longitudinal predictors of post-traumatic growth from the COVID-19 pandemic. Journal of Contextual Behavioral Science, 36, 100894. https://doi.org/10.1016/j.jcbs.2025.100894
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Sun, L., Zou, H., Li, W., Li, H., Pang, J., Cui, H., & Li, C. (2025). Intolerance of uncertainty and emotion regulation in generalized anxiety disorder: The role of reappraisal and suppression. Behavioral Sciences, 15(9), 1238. https://doi.org/10.3390/bs15091238
Tabesh Mofrad, N., & Mansouriyeh, N. (2023). The effectiveness of compassion-based therapy in regulating emotion, self-criticism and anger in male students second secondary level. Journal of Psychological Science, 22(130), 93–110. https://doi.org/10.52547/JPS.22.130.2041
Taghipuor, B., Sharifi, S. F., Barzegaran, R., Seyyedi, S. N., & Ebadi Vahd, L. (2023). The effectiveness of mindful self-compassion training on distress tolerance and emotional inhabitation in students with generalized anxiety disorder. Journal of Modern Psychological Researches, 18(70), 23–29. https://doi.org/10.22034/jmpr.2023.16511
Tang, G., Chen, B., Wu, M., Sun, L., Fan, R., Hou, R., Liu, W., Kang, J., Li, Y., Wang, M., Zhang, Y., Lu, N., Guo, W., Zhang, Y., Li, X., Wei, W., Yu, H., & Li, T. (2025). Effectiveness of mindfulness-based cognitive therapy for treating generalized anxiety disorder and the moderating influence of abuse during childhood: A randomized controlled trial. Journal of Affective Disorders, 379, 510–518. https://doi.org/10.1016/j.jad.2025.02.103
Thompson, B. L., & Zuroff, D. C. (2011). The levels of self-criticism scale: Comparative self-criticism and internalized self-criticism. Personality and Individual Differences, 36(3), 419–430. https://doi.org/10.1016/S0191-8869(03)00106-5
Ventriglio, A., Severo, M., Petito, A., Nappi, L., Iuso, S., Altamura, M., De Masi, L., Gallone, F., Arcidiacono, G., Biancofiore, S., Di Salvatore, M., Palma, G. L., Caroli, A., & Bellomo, A. (2025). Associated factors to generalized anxiety in a sample of women screened for the risk of perinatal depression: A naturalistic study from Italy. Journal of Affective Disorders, 386, 119474. https://doi.org/10.1016/j.jad.2025.119474
Wakelin, K. E., Perman, G., & Simonds, L. M. (2022). Effectiveness of self-compassion-related interventions for reducing self-criticism: A systematic review and meta-analysis. Clinical Psychology and Psychotherapy, 29(1), 1–25. https://doi.org/10.1002/cpp.2586
Werner, A. M., Tibubos, A. N., Rohrmann, S., & Reiss, N. (2019). The clinical impact of self-criticism and its relation to other forms of negative self-evaluation: A systematic review and meta-analysis. Journal of Affective Disorders, 246, 48–62. https://doi.org/10.1016/j.jad.2018.12.056
Wilson, E. J., Abbott, M. J., & Norton, A. R. (2023). The impact of psychological treatment on intolerance of uncertainty in generalized anxiety disorder: A systematic review and meta-analysis. Journal of Anxiety Disorders, 97, 102729. https://doi.org/10.1016/j.janxdis.2023.102729
Zarastvand, A., Tizdast, T., Khalatbari, J., & Abolghasemi, S. (2020). The effectiveness of mindfulness-based cognitive therapy on marital self-regulation, marital burnout and self-criticism of infertile women. Journal of Arak University of Medical Sciences, 23(4), 488–497. https://doi.org/10.32598/jams.23.4.6005.2
Volume 32, Special Issue
December 2025
Pages 75-98

  • Receive Date 22 January 2026
  • Revise Date 17 April 2026
  • Accept Date 09 June 2026