Compassion Focused therapy (CFT) is designed to reduce shame (internal and external) and self-criticism while enhancing the three flows of compassion (compassion to others, from others, and for the self). This systematic review evaluated the effectiveness of CFT on these core theoretical constructs in adult clinical populations. A systematic search of three databases (2000–2024) identified 21 studies (N = 450) meeting the inclusion criteria. The studies were narratively synthesised, and quality was assessed using the EPHPP tool. Consistent improvements in self-compassion (g = 0.23–4.14) and reductions in self-criticism (g = 0.29–1.56) were reported. Reductions in external shame were also observed (g = 0.54–1.22), though this outcome was examined in fewer studies. Limited and inconsistent evidence was found for internal shame and interpersonal compassion flows (compassion to and from others), with only a small number of low- to moderate-quality studies addressing these outcomes. Follow-up effects were rarely assessed, and comparator groups were limited. Most interventions were group-based and of variable methodological quality, with frequent selection bias, small sample sizes, and limited demographic diversity. Overall, CFT shows promise for targeting self-directed processes in clinical populations, though stronger evidence is needed to understand its effects on relational components of compassion. Future research should adopt standardised measures, improve methodological rigour, and recruit more diverse samples.

Understanding the mind–body relationship is increasingly important in healthcare. Dysregulation of the autonomic nervous system (ANS) has been linked to both physical and mental health issues. Heart rate variability biofeedback training (HRVBt), which targets ANS regulation, is gaining popularity and is becoming more portable with advancing technology. While meta-analyses have shown that HRVBt can improve psychological and physiological outcomes, no review has specifically examined portable/remote HRV biofeedback training (P/R-HRVBt). Given the digital transformation of healthcare, this review aimed to evaluate the feasibility and effectiveness of P/R-HRVBt for reducing stress and subclinical anxiety and depression, and to consider its clinical implications. Three databases (PubMed, PsycINFO, Web of Science) and reference lists were searched. Eligible studies were written in English, used P/R-HRVBt, and quantitatively assessed feasibility or effectiveness on psychological outcomes or physiological stress markers in adults experiencing stress or subclinical anxiety and depression. Thirteen studies met the inclusion criteria. Quality was appraised using the Quality Assessment Tool for Quantitative Studies. All studies received a global ‘weak’ rating, though four achieved ‘moderate’ quality when blinding was excluded. Overall, P/R-HRVBt was found to be feasible. All studies reported improvements in at least one psychological or physiological outcome, though heterogeneity in study design, measures, and effect sizes limited conclusions. Further high-quality research is warranted. Nonetheless, findings suggest that P/R-HRVBt may be comparable to established interventions and offers a promising alternative for improving psychological and physiological health.