Therapeutic Benefits of a 16-Week Compassion Focused Therapy for Overeating Are Associated With Positive Autonomic Changes and Putamen Responses
Marques, Cristiana C Sayal, Alexandre Palmeira, Lara Goss, Kenneth Correia, Rita Castilho, Paula Pereira, Ana T Castelo-Branco, Miguel
Marques, Cristiana C
Sayal, Alexandre
Palmeira, Lara
Goss, Kenneth
Correia, Rita
Castilho, Paula
Pereira, Ana T
Castelo-Branco, Miguel
Abstract
Objective: Compassion Focused Therapy (CFT) has shown promise in reducing shame and self-criticism and enhancing compassion in individuals with eating difficulties. However, the neurophysiological mechanisms, particularly those related to learning, are not well understood. This longitudinal study investigated the neurophysiological effects of an online CFT for overeating (CFT-OE) using functional magnetic resonance imaging (fMRI) and heart rate variability (HRV).
Method: A total of 15 women seeking treatment for overeating completed a 16-session group-format CFT-OE program. At pre- and post-intervention, participants completed self-report psychological measures and underwent task-based fMRI with concurrent HRV recordings, in which they engaged in four emotion regulation conditions (avoidance, rumination, self-criticism and self-reassurance). A healthy control group (n = 20) was also recruited and completed a single fMRI scan and self-report psychological measures.
Results: Following the CFT-OE intervention, a reduction in eating disorder symptoms, self-criticism, rumination, and food thought suppression was observed, alongside improvements in self-reassurance and self-compassion. Participants also exhibited increased bilateral putamen activation during self-reassurance, showing normalization to a level comparable to controls, associated with reduced food thought suppression. Right putamen activation during self-criticism was associated with decreases in binge eating. Cortical activation decreased in several prefrontal areas, including the superior and middle frontal gyri. Correlation analysis showed that improvement in self-compassion engagement and action was associated with HRV changes, suggesting a positive modulation of the vagal system.
Conclusions: Results suggest that CFT-OE operates via subcortical mechanisms in the putamen, involved in habit learning, and reduces frontal cortical activity as individuals become more adept at using self-compassion strategies. This shift may reduce emotional reactivity, allowing participants to better manage distress, as reflected by improved vagal tone and decreased prefrontal activation.
MIDER Authors
Date
2025-08
Type
Article
Subject
Feeding and Eating Disorders
Collections
Citation
Marques CC, Sayal A, Palmeira L, Goss K, Correia R, Castilho P, Pereira AT, Castelo-Branco M. Therapeutic Benefits of a 16-Week Compassion Focused Therapy for Overeating Are Associated With Positive Autonomic Changes and Putamen Responses. Int J Eat Disord. 2025 Aug;58(8):1499-1512. doi: 10.1002/eat.24456. Epub 2025 May 5. PMID: 40325978.
Journal / Source Title
International Journal of Eating Disorders
DOI
10.1002/eat.24456
PMID
Publisher
Wiley
Publisher’s URL
https://pubmed.ncbi.nlm.nih.gov/40325978/