A thesis of clinical research and practice: Part A: Do compassion-based interventions reduce symptoms of Disturbed Self Organisation (DSO) in clinical populations aged 18 and over? A Systematic Review of Pre-Post Research Designs; Part B: How do those experiencing complex PTSD understand and experience compassion? A Grounded Theory Analysis; Part C: Summary of clinical practice and assessments

Complex Post-Traumatic Stress Disorder (cPTSD) is a relatively new diagnostic category which accounts for additional difficulties associated with complex trauma reactions including: difficulties with relationships, negative self-concept and difficulties regulating emotions (otherwise termed Disturbances in Self Organisation: DSO). Compassion has been identified as a useful target for interventions aiming to address these additional difficulties. This thesis aimed to determine the whether there is quantitative evidence to suggest that compassion focused interventions (CFIs) address DSO symptomatology, while gaining an understanding of how people with cPTSD understand and experience compassion overall. Part one of this portfolio presents a systematic search of the literature and narrative synthesis for twenty-nine studies investigating the effect of CFIs on each of the DSO symptom domains. Assessments of study quality were also completed. The findings of the review (including 29 studies) showed preliminary evidence that CFIs improve negative self-concept and emotional regulation, with limited evidence for improving interpersonal functioning. However the evidence was of mixed quality, with significant levels of difficulty with internal and external validity. Part two presents an empirical paper that investigated how those with cPTSD understand and experience compassion, in relation to the three flows of compassion (self-compassion, compassion towards others and compassion from others). The findings suggested that those with cPTSD sit on a continuum between embracing and rejecting compassion, with four key processes determining their positioning depending on the flow of compassion: judging the safety of compassion, deciding who deserves compassion, balancing conflicting beliefs about the self and balancing conflicting beliefs about compassion. This is informed by wider contextual factors that reflect early experiences, culture and values. Implications for compassion focused interventions include accounting for contextual influences, backdraft and additional cognitive or attentional processes influencing engagement with compassion.