Comparative Effectiveness of Compassion-Focused Therapy (CFT) and Metacognitive Therapy (MCT) on Experiential Avoidance and Rumination in Women with Major Depressive Disorder

Zahra Ghorbani

Authors

Zahra Ghorbani MA, Department of Educational Psychology, Tabriz Branch, Islamic Azad University, Tabriz, Iran Author https://orcid.org/0000-0002-0287-8453

Keywords:

Compassion-Focused Therapy, Metacognitive Therapy, Experiential Avoidance, Rumination, Major Depressive Disorder, Women

Abstract

Purpose: This study aimed to compare the effectiveness of Compassion-Focused Therapy (CFT) and Metacognitive Therapy (MCT) in reducing experiential avoidance and rumination among women diagnosed with major depressive disorder.

Methods and Materials: This quasi-experimental study employed a pretest–posttest design with a three-month follow-up and a control group. The statistical population consisted of women with major depressive disorder who attended comprehensive health service centers and psychological clinics in Tabriz, Iran, in 2026. Using purposive sampling, 45 eligible women diagnosed through the Structured Clinical Interview for DSM Disorders (SCID) were selected and randomly assigned to three groups of 15 participants: CFT, MCT, and control. Data were collected using the Beck Depression Inventory-II (BDI-II), Acceptance and Action Questionnaire-II (AAQ-II), and Ruminative Responses Scale (RRS). The CFT group received eight 90-minute sessions of compassion-focused therapy, while the MCT group received eight 90-minute sessions of metacognitive therapy. The control group remained on a waiting list. Data were analyzed using repeated-measures analysis of variance and Bonferroni post hoc tests at a significance level of .05.

Findings: Repeated-measures analysis showed significant effects of time, group, and the time × group interaction on both experiential avoidance and rumination. Bonferroni post hoc comparisons indicated that both CFT and MCT produced significantly greater reductions in experiential avoidance and rumination than the control condition at posttest and three-month follow-up. Moreover, comparisons between the two intervention groups demonstrated that CFT resulted in significantly greater and more sustained reductions in both experiential avoidance and rumination than MCT, indicating superior maintenance of therapeutic gains over the follow-up period.

Conclusion: Both CFT and MCT appear effective for addressing cognitive and emotional processes associated with major depressive disorder; however, CFT demonstrated greater and more persistent effects on experiential avoidance and rumination. By targeting shame, self-criticism, and self-blame while cultivating self-compassion and internal safeness, CFT may offer particular advantages for women with major depressive disorder and may be considered a potentially preferable intervention for achieving sustained psychological improvement.

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