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Generalized anxiety disorder (GAD), characterized by persistent and excessive worry, exhibits high treatment resistance. While self-compassion training shows promise in alleviating anxiety, its acute effects on stress-related autonomic regulation in GAD remain unclear. This randomized controlled trial examined whether a single-session compassionate self-talk protocol improves emotional and autonomic stress responses in GAD, focusing on high-frequency heart rate variability (HF-HRV) as an index of parasympathetic engagement. Forty-six clinically diagnosed GAD participants were randomly assigned to either a compassionate self-talk group (n = 23) or a neutral self-talk control (n = 23). Participants completed a cognitive stress task (time-limited Raven's matrices with evaluative feedback) with continuous electrocardiogram (ECG) recording. State anxiety (STAI-S), perceived stress, state self-compassion (SSCS), and affect (PANAS) were assessed pre- and post-intervention. The self-compassion group showed greater reductions in perceived stress (t ₍₄₄₎  = -2.09, p = 0.043, d = 0.62) and increased positive affect (t ₍₄₄₎  = 2.29, p = 0.028, d = 0.67), though no significant group differences emerged for state anxiety or state self-compassion. During stress exposure, HF-HRV was significantly higher in the self-compassion group (t ₍₃₇₎  = 2.15, p _corrected  = 0.038) during a late post-feedback interval. Correlational analyses revealed that increased state self-compassion correlated with reduced stress (r = -0.54, p = 0.001) and anxiety (r = -0.45, p = 0.010). These findings suggest that brief compassionate self-talk may improve subjective stress coping in GAD and may be associated with altered event-related autonomic dynamics during cognitive stress. Given the modest sample and ultra-short HRV segments, physiological interpretations warrant a cautious approach. Future studies may test whether combining self-compassion training with HRV biofeedback optimizes intervention efficacy in clinical settings.

ChiCTR.org.cn, identifier ChiCTR2100053374.