Therapeutic Benefits of a 16‐Week Compassion Focused Therapy for Overeating Are Associated With Positive Autonomic Changes and Putamen Responses

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.