Effectiveness of Emotion-Focused Therapy for Self-Criticism: A Systematic Review and Meta-Analysis

Problematic self-criticism has been widely recognised as a transdiagnostic factor associated with a range of mental health disorders. Emotion-focused therapy (EFT) targets self-criticism primarily via two-chair dialogue for self-criticism, a core intervention within the approach. An increasing number of pre-post studies and randomised controlled trials (RCTs) have examined the effectiveness of EFT in reducing self-criticism. The present meta-analysis synthesised existing quantitative studies utilising EFT to reduce self-criticism and evaluated its overall effectiveness across study designs. Four pre-post studies and seven RCTs were identified through a systematic literature search. Effect sizes were calculated separately for 11 within-group pre-post EFT intervention groups (four single-arm pre-post studies and seven RCT intervention groups) and seven between-group RCT comparisons. Study quality, risk of bias and sensitivity analyses were conducted. Using random-effects models, the pooled within-group effect size (Hedges' g) was -0.86, and the pooled between-group effect size in RCTs was -0.73, indicating moderate to large effects of EFT in reducing self-criticism. Leave-one-out sensitivity analyses showed that these effects remained robust after the removal of outliers. This meta-analysis provides the first quantitative synthesis of EFT for self-criticism and offers preliminary evidence supporting its effectiveness in addressing this transdiagnostic factor linked to the number of mental health difficulties.