Effectiveness of Compassion-Focused Therapy in Improving Self-Esteem, Resilience, and Quality of Life among Individuals with Differences of Sex Development: A Quasi-Experimental Study

Abstract

Differences of Sex development (DSD) usually experience psychological and psychosocial challenges due to their conditions that make them feel guilty, ashamed and self-critical, thus affecting their self-esteem, resilience, and quality of life.  Despite the increasing importance of the care of DSD, there is still limited psychological management for them. Compassion-Focused Therapy (CFT) is a new, effective approach developed to improve self-compassion and emotional resilience, which reduces stigma and psychological distress, thus improving overall quality of life. Therefore, the present study’s main objective was to evaluate the effectiveness of the compassion-focused therapy in improving self-esteem, resilience, and quality of life among individuals with differences of sex development. The quasi-experimental study was conducted from June 2025 to January 2026. The sample consisted of 60 individuals with differences in sex development ranged in age from 18-40 years. The sample was selected through purposive sampling from two public hospitals of Peshawar. The sample was divided into two groups of 30 individuals each, i.e. experimental and control group. The RSA, RSES, and WHOQOL were used for both the pretesting and post testing period. The experimental group received compassion-focused therapy with different techniques like calming breath exercises and compassionate visualization, while the control group received the standard treatment. At post testing period the results indicated that participants in the experimental group showed significantly higher levels of self-esteem (M = 40.85) compared to the control group (M = 34.05), t = 5.47, p < .001. Similarly, the experimental group reported significantly greater resilience (M = 118.47 vs. 101.42), t = 4.92, p < .001, and quality of life (M = 74.65 vs. 61.48), t = 5.12, p < .001, than the control group. The Cohen's d values varied between 1.35 and 1.48, indicating large effect sizes, suggesting that Compassion-Focused Therapy results in large and meaningful effects on psychosocial functioning. These results gave us empirical answers that the therapeutic intervention was very effective in improving the psychological state of people with Differences in Sex Development in the experimental group.