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CompassionCompassion--FocusedFocused--Therapy Therapy
Model and ResearchModel and Research
Paul Gilbert, Kirsten McEwan, Corinne Gale & Jean GilbertPaul Gilbert, Kirsten McEwan, Corinne Gale & Jean Gilbert
Mental Health Research UnitMental Health Research Unit, ,
Kingsway Hospital, Derby UKKingsway Hospital, Derby UK
www: Compassionatemind.co.ukwww: Compassionatemind.co.uk
Talk TodayTalk Today
OutlineOutline basicbasic philosophyphilosophy andand modelmodel ofof
CompassionCompassion focusedfocused TherapyTherapy
NoteNote thethe powerfulpowerful effectseffects ofof ourour selfself--
evaluationevaluation systemssystems (self(self--criticismcriticism vsvs selfselfevaluationevaluation systemssystems (self(self--criticismcriticism vsvs selfself
compassion)compassion)
ExploreExplore thethe mainmain therapeutictherapeutic workwork asas
overcomingovercoming thethe fearfear ofof compassioncompassion andand selfself
compassionscompassions
To understand ourselves we must To understand ourselves we must
understand our brainsunderstand our brains
why we have complex brains and minds that are why we have complex brains and minds that are
difficult to understand regulatedifficult to understand regulate
1. Old Brain 1. Old Brain
Emotions:Emotions: Anger, anxiety, sadness, joy, lustAnger, anxiety, sadness, joy, lust
Behaviours:Behaviours: Fight, flight, withdraw, engageFight, flight, withdraw, engage
Relationships:Relationships: Sex, status, attachment, tribalismSex, status, attachment, tribalism
2. New Brain2. New Brain
Imagination, fantasise, look back and forward, plan, ruminateImagination, fantasise, look back and forward, plan, ruminateIntegration of mental abilitiesIntegration of mental abilitiesIntegration of mental abilitiesIntegration of mental abilities
SelfSelf--awareness, selfawareness, self--identity, and selfidentity, and self--feelingfeeling
3. Social Brain3. Social Brain
Need for affection and care Need for affection and care
Socially responsive, selfSocially responsive, self--experience and motivesexperience and motives
What happens when new brain is recruited to pursue old brain passions?What happens when new brain is recruited to pursue old brain passions?
Sources of behaviourSources of behaviour
Old BrainOld Brain: Emotions, Motives, Relationship : Emotions, Motives, Relationship
New BrainNew Brain:: Imagination, Imagination,
Planning, Rumination, IntegrationPlanning, Rumination, Integration
Interaction of old and new psychologies
Old BrainOld Brain: Emotions, Motives, Relationship : Emotions, Motives, Relationship
SeekingSeeking--CreatingCreating
ArchetypalArchetypal
Understanding our Motives and Understanding our Motives and
EmotionsEmotions
Motives evolved because they help animals to Motives evolved because they help animals to survive and leave genes behindsurvive and leave genes behind
Emotions guide us to our goals and respond if we Emotions guide us to our goals and respond if we are succeeding or threatenedare succeeding or threatened
There are three types of emotion regulationThere are three types of emotion regulation
1.1. Those that focus on threat and selfThose that focus on threat and self--protectionprotection
2.2. Those that focus on doing and achievingThose that focus on doing and achieving
3.3. Those that focus on contentment and feeling safeThose that focus on contentment and feeling safe
Types of Affect Regulator SystemsTypes of Affect Regulator Systems
Incentive/resourceIncentive/resource--
focusedfocused
Wanting, pursuing,
achieving, consuming
NonNon--wanting/wanting/
Affiliative focusedAffiliative focused
Safeness-kindness
Soothing
Drive, excite, vitalityDrive, excite, vitality Content, safe, connectedContent, safe, connected
achieving, consuming
Activating
Soothing
ThreatThreat--focused focused
Protection andProtection and
SafetySafety--seekingseeking
Activating/inhibitingActivating/inhibiting
Anger, anxiety, disgustAnger, anxiety, disgust
SelfSelf--ProtectionProtection
InIn speciesspecies withoutwithout attachmentattachment onlyonly
11--22%% makemake itit toto adulthoodadulthood toto
reproducereproduce.. ThreatsThreats comecome fromfrom
ecologies,ecologies, foodfood shortage,shortage, predation,predation,ecologies,ecologies, foodfood shortage,shortage, predation,predation,
injury,injury, diseasedisease.. AtAt birthbirth individualsindividuals
mustmust bebe ableable toto “go“go itit alone”alone” bebe
mobilemobile andand dispersedisperse
Protect and Comfort: Less ‘instinctive Protect and Comfort: Less ‘instinctive
brain brain –– post birth learningpost birth learning
The Mammalian Importance of The Mammalian Importance of
Caring MindsCaring Minds
CaringCaring asas “looking“looking after”after”.. SeekingSeeking closenesscloseness
ratherrather thanthan dispersiondispersion.. IndividualsIndividuals obtainobtain
protection,protection, food,food, andand carecare whenwhen illill.. KeyKey alsoalso isis
soothingsoothing--calmingcalming andand physiologicalphysiological regulationregulation..
FewFew offspringoffspring butbut highhigh survivalsurvival raterate ininFewFew offspringoffspring butbut highhigh survivalsurvival raterate inin
comparisoncomparison toto speciesspecies withoutwithout attachmentattachment..
AffectionAffection andand kindnesskindness
CoCo--operativeoperative andand mutualmutual supportsupport cancan developdevelop asas
wewe seesee thatthat ourour prosperityprosperity impactsimpacts onon thatthat ofof
others,others, sharingsharing andand notnot--exploitingexploiting
Affectionate InteractionsAffectionate Interactions
Secure attachment linked to selfSecure attachment linked to self--confidence, empathy and use confidence, empathy and use of attachment strategies when stressed (Mikulincer & Shaver of attachment strategies when stressed (Mikulincer & Shaver 2005)2005)
Maturation of the brain (e.g. frontal cortex) and affect Maturation of the brain (e.g. frontal cortex) and affect regulation (Gerhardt, 2004; Schore, 1994)regulation (Gerhardt, 2004; Schore, 1994)
Effects of low birth weight (Tully et al, 2004. JCCP, 72, 218Effects of low birth weight (Tully et al, 2004. JCCP, 72, 218--226)226)
Testosterone and aggression (Booth et al., 2003. Testosterone and aggression (Booth et al., 2003. Developmental Psychology, 39, 85 Developmental Psychology, 39, 85 –– 98)98)
SelfSelf--toto--selfself--relating e.g. self criticism relating e.g. self criticism vsvs selfself--reassurancereassurance
Internal Threat and SoothingInternal Threat and Soothing
Threat
Affiliative/ Soothing
Calms
Self-affiliation –
experiences a lovable self
Internal representations of helpful
others and sources of comfort
Emotional memories of
soothing
Neurophysiological
networks
Internal Threat and More threatInternal Threat and More threat
Threat
Affiliative/ Soothing
Calms
No self-affiliation –
experiences a ununlovable
self
Others are threats or
alarming
Emotional memories of no
soothing
Neurophysiological
networks
Compassion SolutionsCompassion Solutions
Ancient wisdomAncient wisdom
Compassion is the road to happiness Compassion is the road to happiness
(Buddhism(Buddhism))
Evolution Evolution Evolution Evolution
Evolution has made our brains highly Evolution has made our brains highly
sensitive to internal and external kindnesssensitive to internal and external kindness
NeuroscienceNeuroscience
Specific brain areas are focused on detecting Specific brain areas are focused on detecting
and responding to kindness and compassionand responding to kindness and compassion
CompassionCompassion
CompassionCompassion cancan bebe defineddefined inin manymany waysways:: “As“As aasensitivitysensitivity toto thethe sufferingsuffering ofof selfself andand othersothers withwith aadeepdeep commitmentcommitment toto trytry toto relieverelieve it”it” DalaiDalai LamaLama
EightEight foldfold pathpath -- representsrepresents aa multimulti--modalmodalapproachapproach forfor trainingtraining one’sone’s mindmind
Compassion as FlowCompassion as Flow
Different practices for eachDifferent practices for each
OtherOther SelfSelf
SelfSelf OtherOther
SelfSelf SelfSelf
NonNon linearlinear empathyempathy forfor otherother beginsbegins earlyearly inin lifelife
DataData•• PracticePractice ofof imaginingimagining compassioncompassion forfor othersothers producesproduces changeschanges inin
frontalfrontal cortexcortex andand immuneimmune systemsystem (Lutz(Lutz etet al,al, 20092009))
•• LovingLoving kindnesskindness meditationmeditation (compassion(compassion directeddirected toto self,self, thenthenothers,others, thenthen strangers)strangers) increasesincreases positivepositive emotions,emotions, mindfulness,mindfulness,feelingsfeelings ofof purposepurpose inin lifelife andand socialsocial supportsupport andand decreasesdecreases illnessillnesssymptomssymptoms (Frederickson(Frederickson etet al,al, 20082008,, JPSP)JPSP)
•• CompassionCompassion meditationmeditation ((66 weeks)weeks) improvesimproves immuneimmune function,function, andandneuroendocrineneuroendocrine andand behaviouralbehavioural responsesresponses toto stressstress (Pace,(Pace, 20082008,,PNE)PNE)
•• ViewingViewing sadsad faces,faces, neutrallyneutrally oror withwith aa compassionatecompassionate attitudeattitudeinfluencesinfluences neurophysiologicalneurophysiological responsesresponses toto facesfaces (Ji(Ji--WoongWoong Kim,Kim,20092009,, NP)NP)
•• CompassionCompassion trainingtraining reducesreduces shameshame andand selfself--criticismcriticism inin chronicchronicdepresseddepressed patientspatients (Gilbert(Gilbert && Proctor,Proctor, 20062006,, CPP)CPP)
Key Targets of TherapyKey Targets of Therapy
AttentionAttentionThinkingThinking
ReasoningReasoning
BehaviourBehaviourImagery Imagery FantasyFantasy BehaviourBehaviour
MotivationMotivation EmotionsEmotions
Their pattern gives rise to a certain type of mindTheir pattern gives rise to a certain type of mind
FantasyFantasy
Compassionate MindCompassionate Mind
AttentionAttentionThinkingThinking
ReasoningReasoning
BehaviourBehaviourImagery Imagery FantasyFantasy CompassionCompassion BehaviourBehaviour
MotivationMotivation EmotionsEmotions
FantasyFantasy CompassionCompassion
Threatened Mind can block CompassionThreatened Mind can block Compassion
AttentionAttentionThinkingThinking
ReasoningReasoning
BehaviourBehaviourImagery Imagery FantasyFantasy ThreatThreat BehaviourBehaviour
MotivationMotivation EmotionsEmotions
FantasyFantasy ThreatThreat
SelfSelf--Critical Mind is also ThreatCritical Mind is also Threat--focused focused
MindMind
AttentionAttentionThinkingThinking
ReasoningReasoning
BehaviourBehaviourImagery Imagery FantasyFantasy
SelfSelf--
CriticalCriticalBehaviourBehaviour
MotivationMotivation EmotionsEmotions
FantasyFantasy CriticalCritical
Meal
SexualBully-threat
Emotion BrainEmotion BrainEmotion BrainEmotion Brain
How our own thoughts and images affect our brainsHow our own thoughts and images affect our brains
Kind, warm
and caring
Meal Sex Bully-
threat
CompassionEmotion BrainEmotion BrainEmotion BrainEmotion Brain
Stomach acid
Salvia Arousal
Fearful
Depressed
Soothed
Safe
Compassion
Pink represents our inner images and thoughts
QuestionsQuestions
HowHow doesdoes selfself--criticismcriticism andand selfself--compassion/compassion/
reassurancereassurance workwork inin thethe brain?brain?
AreAre theirtheir individualindividual differencesdifferences linkedlinked toto traittraitAreAre theirtheir individualindividual differencesdifferences linkedlinked toto traittrait
selfself-- criticism?criticism?
HowHow mightmight compassioncompassion trainingtraining influenceinfluence
neurophysiology?neurophysiology?
fMRI Study (Aston University)STUDY Olivia Longe, Gina Rippon, Paul Gilbert & Frankie Maratos
Self-Reassure
Self-Criticize
Self-Reassure
Self-Criticize
• 2X2 Factorial: 2 X Statement Scenarios, 2 X Imagery Perspectives
• Statements pre-tested (n=12), for imagability (i.e. ease of imagining self-critical or self-reassuring thoughts), 1-7 Likert Scale.
Emotion Scenario(-) Neutral Scenario
“A third job rejection letter in a row arrives in the post”
“The second free local newspaper in a row arrives in the post”.
Self-Criticism during Emotional Scenarios vs. Neutral
Axial slices displaying left lateral PFC (BA 47, 45,9) and right lateral
PFC (BA 46) activation
Longe, et al (2010). Having a word with yourself: NeuroImage, 49, 1849-1856
Self-Reassurance during Emotional Scenarios vs.
Neutral
Whole brain and axial slices displaying left temporal pole (BA
38) and insula activation
Longe, et al (2010). Having a word with yourself: NeuroImage, 49, 1849-1856
Parent recall and SC and SRParent recall and SC and SRIrons Gilbert Baldwin et al., 2006 Br J Clin PsychIrons Gilbert Baldwin et al., 2006 Br J Clin Psych
Rejection Inadequate
Self
.24
(.31)
.26
(.60)
.15
(.25)
.31
(.33)
Overprotection
Warmth
Hated Self
Reassure Self
Depression
.37
(.30)
-.31
(-.56)
.22
(.55)
Parent recall and SC and SRParent recall and SC and SRIrons Gilbert Baldwin et al., 2006 Br J Clin PsychIrons Gilbert Baldwin et al., 2006 Br J Clin Psych
Rejection Inadequate
Self
.24
(.31)
.26
(.60)
.15
(.25)
.31
(.33)
Overprotection
Warmth
Hated Self
Reassure Self
Depression
.37
(.30)
-.31
(-.56)
.22
(.55)
Imagining a selfImagining a self--critical part of selfcritical part of self
197 students from Derby and McGill Universities197 students from Derby and McGill Universities
(with Chris Irons and Mark Baldwin)(with Chris Irons and Mark Baldwin)
SelfSelf--criticismcriticism
PowerPower AngerAngerPowerPower AngerAnger
0.530.53 0.510.51
SelfSelf--reassurancereassurance
PowerPower AngerAnger
-- 0. 330. 33 -- 0.330.33
Imagining a SelfImagining a Self--Compassionate Compassionate
Part of SelfPart of Self
197 students from Derby and McGill Universities197 students from Derby and McGill Universities
(with Chris Irons and Mark Baldwin)(with Chris Irons and Mark Baldwin)
SelfSelf--criticismcriticism
PowerPower WarmWarmPowerPower WarmWarm
-- 0.540.54 -- 0.340.34
SelfSelf--reassurancereassurance
PowerPower warmwarm
0. 580. 58 0.430.43
Gilbert et al (2005)Gilbert et al (2005)
Compassionate MindCompassionate Mind
AttentionAttentionThinkingThinking
ReasoningReasoning
BehaviourBehaviourImagery Imagery FantasyFantasy
SelfSelf--CompassionateCompassionate BehaviourBehaviour
MotivationMotivation EmotionsEmotions
FantasyFantasy CompassionateCompassionate
Why a Compassion Focus?Why a Compassion Focus?
PeoplePeople withwith chronicchronic problemsproblems oftenoften comecome fromfromneglectfulneglectful oror abusiveabusive backgrounds,backgrounds, havehave highhighlevelslevels ofof shame,shame, andand areare oftenoften selfself--critical,critical, selfself--disliking,disliking, oror selfself--hatinghating
LiveLive inin aa worldworld ofof constantconstant internalinternal andand externalexternalLiveLive inin aa worldworld ofof constantconstant internalinternal andand externalexternalthreatthreat
HaveHave fewfew experiencesexperiences ofof feelingfeeling safesafe oror soothedsoothedandand areare notnot ableable toto dodo thisthis forfor themselvesthemselves.. OftenOftendodo poorlypoorly inin trialstrials
Self-Criticism
Internal Threat and SoothingInternal Threat and Soothing
Worry Threat
Compassionate
Re-focusing
Affiliative/ Soothing
Calms
Rumination
Worry Soothing
Compassionate imagery
Fear of CompassionFear of Compassion
Certain types of positive feelings are threateningCertain types of positive feelings are threatening
It is dangerous to feel safeIt is dangerous to feel safe
Compassion feeling are linked to beliefs such that Compassion feeling are linked to beliefs such that
it’s an indulgence and weaknessit’s an indulgence and weakness
Activated grief and or abuse memoriesActivated grief and or abuse memories
PROBLEM PROBLEM --Compassion is a threatCompassion is a threat
Threat
Compassionate
Re-focusing
Affiliaitve/Soothing
Compassionate imagery
Shame-self
criticism
Trauma
Memory
Meta- beliefsFear of
closeness
Mentalizing
Kindness, Attachment and ThreatKindness, Attachment and Threat
Kindness from therapist or imageryKindness from therapist or imagery
Activate attachment systemActivate attachment system
Activate memoriesActivate memoriesFight, flightFight, flight Fight, flightFight, flight
shut downshut down
NeglectNeglect
alonenessaloneness
Abuse, shame Abuse, shame vulnerablevulnerable
ActivateActivate learnt and current defences learnt and current defences -- cortisolcortisol
shut downshut down shut downshut down
Bowlby: Kindness opens the attachment system and then whatever ever fears, anger Bowlby: Kindness opens the attachment system and then whatever ever fears, anger or despair is coded there will become available and can be intensely threateningor despair is coded there will become available and can be intensely threatening
Study of reactions to Study of reactions to
compassionate imagerycompassionate imagery
•• ControlControl ofof thethe mechanismsmechanisms forfor balancebalance betweenbetweensympatheticsympathetic andand parasympatheticparasympathetic nervousnervous systemsystem havehavebeenbeen modifiedmodified andand areare linkedlinked toto evolutionevolution ofof mammalian,mammalian,attachmentattachment andand socialsocial engagementengagement systemssystemsattachmentattachment andand socialsocial engagementengagement systemssystems
•• ThisThis relativerelative balancebalance cancan bebe measuredmeasured inin heartheart rateratevariabilityvariability
•• HeartHeart raterate variabilityvariability linkedlinked toto adaptiveadaptive balancebalance andandflexibility,flexibility, soothingsoothing andand safenesssafeness -- lowlow variabilityvariability totorelativerelative control/dominancecontrol/dominance ofof oneone overover thethe otherother -- threatthreat
Parasympathetic Parasympathetic
nerves to heartnerves to heart
Slows HRSlows HR
Sympathetic Sympathetic
nerves to heartnerves to heart
Increases HR and Increases HR and
stroke volumestroke volume
Successive InterSuccessive Inter--beat Intervals beat Intervals
(ms) (ms)
945945
897897
858858
799799
821821
846846
851851
858858
879879
879879
Standard Deviation of Standard Deviation of InterInter--beat Intervals beat Intervals over 300 second over 300 second period = SDNNperiod = SDNN
Tasks of studyTasks of study
RelaxationRelaxation conditioncondition waswas focusingfocusing onon relaxingrelaxing
calmingcalming images/thoughtsimages/thoughts
ControlControl conditioncondition waswas toto imagineimagine makingmaking youryour
favouritefavourite sandwichsandwich andand thethe pleasurepleasure youyou willwill getgetfavouritefavourite sandwichsandwich andand thethe pleasurepleasure youyou willwill getget
fromfrom eatingeating itit (control(control forfor typetype ofof positivepositive affectaffect andand
alsoalso thethe effectseffects ofof mentalmental imagery)imagery)
CompassionCompassion imageryimagery waswas toto imagineimagine theirtheir idealideal
compassionatecompassionate personperson andand howhow kind,kind, warmwarm andand
caringcaring theythey werewere forfor thethe selfself
65.00
60.00
55.00
Mean SDNN
Grp 2 ups
Grp 1downs
SDNN change grouping variable
Diagram showing mean SDNN for each group at baseline & during imagery conditions
Compassionate Imagery
Control ImageryBaseline
Condition
50.00
45.00
40.00
Mean SDNN
5.800
5.600
5.400
Mean cortisol (ng/ml)
Grp 2ups
Grp 1downs
Grouping variabile for SDNN change
Diagram showing mean cortisol for each group at baseline & after Imagery
CortBCortA
Sample
5.200
5.000
4.800
Mean cortisol (ng/ml)
Correlations between change in HRV Correlations between change in HRV
and selfand self--report scalesreport scales
SDNNSDNN
Inadequate SelfInadequate Self Anxious AttachmentAnxious Attachment
--.54*.54* --.48*.48*
Depend AttachmentDepend Attachment Social SafenessSocial Safeness
.52*.52* .57**.57**
* p<.05 ** p <.01* p<.05 ** p <.01
Fears of CompassionFears of Compassion
Basic Beliefs and MetaBasic Beliefs and Meta--cognitionscognitionsBasic Beliefs and MetaBasic Beliefs and Meta--cognitionscognitions
Fear of Compassion Fear of Compassion ForFor Others Others
ScaleScale
PeoplePeople willwill taketake advantageadvantage ofof youyou ifif youyou areare
tootoo compassionatecompassionate
IfIf I’mI’m tootoo compassionate,compassionate, othersothers willwill becomebecome
tootoo dependentdependent onon meme
II can’tcan’t toleratetolerate othersothers distressdistress
Fear of Compassion Fear of Compassion FFromrom Others Others
ScaleScale
II fearfear thatthat ifif II needneed otherother peoplepeople toto bebe kind,kind, theytheywontwont bebe
II worryworry thatthat peoplepeople areare onlyonly kindkind andandcompassionatecompassionate ifif theythey wantwant somethingsomething fromfrom meme
IfIf II thinkthink someonesomeone isis beingbeing kindkind && caringcaring towardstowardsme,me, II putput upup aa barrierbarrier
Fear of Compassion Fear of Compassion Towards Towards
SelfSelf ScaleScale
I fear that if I develop compassion for I fear that if I develop compassion for
myself, I will become someone I don’t want myself, I will become someone I don’t want
to beto be
I fear that if I am more selfI fear that if I am more self--compassionate compassionate
I will become a weak personI will become a weak person
I fear that if I start to feel compassion for I fear that if I start to feel compassion for myself, myself,
I will be overcome with loss/griefI will be overcome with loss/grief
Fear of Compassion DataFear of Compassion Data
Com Com for for
others others
Com Com fromfrom
OthersOthers
Com Com for for
othersothers
Com Com fromfrom
OthersOthers. 47**. 47**
SelfSelf comcom . 37**. 37** . 67**. 67**
Fear of Compassion DataFear of Compassion Data
C C forfor
OthersOthers
C C fromfrom
OthersOthers
Self Self ComCom
AnxietyAnxiety . 22**. 22** . 46**. 46** . 44**. 44**AnxietyAnxiety . 22**. 22** . 46**. 46** . 44**. 44**
DepDep . 17*. 17* . 37**. 37** . 40*. 40*
Tentative ideasTentative ideas
ToTo emotionalemotional (shame(shame type)type) eventsevents -- beingbeing selfself--
reassuringreassuring vsvs selfself--criticalcritical activatesactivates differentdifferent brainbrain
systemssystems
PeoplePeople highhigh inin selfself--criticismcriticism seemseem toto strugglestruggle totoPeoplePeople highhigh inin selfself--criticismcriticism seemseem toto strugglestruggle toto
activateactivate soothingsoothing systemsystem andand maymay findfind effortsefforts toto bebe selfself
--compassionatecompassionate aa threatthreat –– (sadness?)(sadness?)
QuestionQuestion:: cancan wewe teachteach selfself--criticscritics toto bebe selfself soothingsoothing
andand wouldwould thisthis ‘training‘training affect’affect’ changechange physiologicalphysiological
responsesresponses toto threateningthreatening--selfself linkedlinked events?events?
TherapyTherapy
Life history and contextual rather than symptom focusedLife history and contextual rather than symptom focused
Background, key threats, safety strategies Background, key threats, safety strategies undesired/unintended consequenceundesired/unintended consequence
High focus on validation, on “not your fault,” courage and High focus on validation, on “not your fault,” courage and doing your best.doing your best.doing your best.doing your best.
Clarify three circle model and why we will explore helpful Clarify three circle model and why we will explore helpful behaviour for behaviour for eacheach circlescircles
Desensitisation to affiliative positive affect Desensitisation to affiliative positive affect –– to be able to to be able to feel safe and self compassionatefeel safe and self compassionate
TreatmentTreatment
•• Attendance one of two programmesAttendance one of two programmes
•• Patients invited to take part in a research trial of Patients invited to take part in a research trial of
CMT at community meetingsCMT at community meetings
•• Criteria for inclusion were mid treatment (six months Criteria for inclusion were mid treatment (six months
to one year), well engaged with the service and to have to one year), well engaged with the service and to have
selfself--attacking, negative thoughtsattacking, negative thoughtsselfself--attacking, negative thoughtsattacking, negative thoughts
•• Nine patients agreed to take part in the study (five Nine patients agreed to take part in the study (five
men and four women)men and four women)
•• Three did not complete the study: hence six completed Three did not complete the study: hence six completed
•• Twelve two hour sessionsTwelve two hour sessions
•• Gradual process of developing compassionate imagery Gradual process of developing compassionate imagery
and soothing exercises and then engaging with self and soothing exercises and then engaging with self
critical thinking critical thinking
Data From Group StudyData From Group Study
Pre and Post Compassionate Mind
Training
54.2 56.4
50
60
10.2
18.8
0
10
20
30
40
Self criticism Self compassion
Scale
Before
After
Data From Group StudyData From Group Study
Functions of Self-to-Self Relating
28
(15.79)
17.5
21.67
(11.74)25
30
17.5
(8.62)
9.6
(8.45)
0
5
10
15
20
Self Correction Self Persecution
Score Before
After
Data From Group StudyData From Group Study
HADS
10.33
(2.67)
14.67
(3.78)
10
12
14
16
4.3
(2.73)
6.83
(2.93)
0
2
4
6
8
10
Anxiety Depression
Subscale
Score Before
After
Data From Group StudyData From Group Study
Forms of Self-to-Self Relating
31.33
(5.16)
15.17
(3.76)
14.5
(7.01)
19.83
(8.21)20
25
30
35
Score (3.76)
6.17
(6.40)
(7.01)
5.67
(5.40)
0
5
10
15
Inadeq
uate Self
Hated self
Reassure Self
Score
Before
After
Data From Group StudyData From Group Study
Others as Shamer
48 .5
( 17 . 2 7 )
36 . 3 3
( 12 . 13 )40
50
60
Social Comparison
3 4 .8 3
58 .6 7
( 2 6 .0 0 )
40
50
60
70
( 12 . 13 )
0
10
20
30
40
Ot hers as Shamers
Before
After
3 4 .8 3
( 2 1.50 )
0
10
20
30
40
Social
comparison
Score Before
After
ReflectionsReflections
II wouldwould justjust likelike toto telltell youyou allall herehere todaytoday whatwhat (CMT)(CMT)meansmeans toto meme.. ItIt seemedseemed toto awakenawaken aa partpart ofof mymy brainbrain thatthatII waswas notnot awareaware existedexisted..
TheThe feelingfeeling ofof onlyonly everever havinghaving compassioncompassion forfor otherotherpeoplepeople andand nevernever everever contemplatingcontemplating havinghaving anyany forformyselfmyself..
SuddenlySuddenly realisingrealising thatthat it’sit’s alwaysalways beenbeen there,there, justjust thatthat IISuddenlySuddenly realisingrealising thatthat it’sit’s alwaysalways beenbeen there,there, justjust thatthat IIhavehave nevernever knewknew howhow toto useuse itit towardstowards myselfmyself..
ItIt waswas suchsuch aa beautiful,beautiful, calmingcalming feelingfeeling toto knowknow itit waswas OkOktoto feelfeel likelike thisthis towardstowards myselfmyself withoutwithout feelingfeeling guiltyguilty ororbadbad aboutabout itit..
BeingBeing ableable toto drawdraw onon thisthis whenwhen II waswas frightenedfrightened andandconfused,confused, toto calmcalm myselfmyself downdown andand toto putput thingsthings ininprospectiveprospective andand saysay toto myselfmyself “IT’S“IT’S OKOK TOTO FEELFEEL LIKELIKETHISTHIS..
ReflectionsReflections
HavingHaving compassioncompassion forfor myselfmyself meansmeans II feelfeel soso muchmuch moremore atatpeacepeace withwith myselfmyself.. KnowingKnowing thatthat itit isis aa normalnormal wayway ofof lifelife totohavehave compassioncompassion forfor myselfmyself andand it’sit’s notnot anan abnormalabnormal wayway ofofthinking,thinking, butbut aa veryvery healthyhealthy wayway ofof thinkingthinking.. ItIt feltfelt likelike IIwaswas trainingtraining mymy mindmind toto switchswitch toto thisthis modemode whenwhen II startstart totofeelfeel badbad aboutabout myselfmyself oror lifelife situationssituations werewere startingstarting toto getgetonon toptop ofof meme..onon toptop ofof meme..
WhatWhat isis strikingstriking aboutabout this,this, andand whatwhat otherother participantsparticipantsthought,thought, waswas howhow muchmuch theythey hadhad (previously)(previously) feltfelt thatthat beingbeingselfself--compassionatecompassionate andand empathicempathic toto one’sone’s distressdistress waswas aa selfself--indulgenceindulgence oror weaknessweakness andand definitelydefinitely notnot somethingsomething totocultivatecultivate..
Mayhew and Gilbert 2008Mayhew and Gilbert 2008
Three voices hearers with CFTThree voices hearers with CFT
ResultsResults showedshowed decreasesdecreases forfor allall participantsparticipants
inin depression,depression, psychoticism,psychoticism, anxiety,anxiety,
paranoia,paranoia, OCDOCD andand interpersonalinterpersonal sensitivitysensitivity..
AllAll participants’participants’ auditoryauditory hallucinationshallucinations
becamebecame lessless malevolent,malevolent, lessless persecutingpersecuting andand
moremore reassuringreassuring
Some other studies
Laithwaite et al., (2010) (University of Glasgow) in a Laithwaite et al., (2010) (University of Glasgow) in a
study of group based CFT study for 19 clients in a high study of group based CFT study for 19 clients in a high
security psychiatric at Carstairs found security psychiatric at Carstairs found
“… a large magnitude of change for levels of “… a large magnitude of change for levels of “… a large magnitude of change for levels of “… a large magnitude of change for levels of
depression and selfdepression and self--esteem ….. A moderate magnitude esteem ….. A moderate magnitude
of change was found for the social comparison scale of change was found for the social comparison scale
and general psychopathology, with a small magnitude and general psychopathology, with a small magnitude
of change for shame. These changes were maintained of change for shame. These changes were maintained
at 6at 6--week followweek follow--upup”.”.
ConclusionsConclusions•• CFT linked to evolved and neurophysiological systems : Must CFT linked to evolved and neurophysiological systems : Must
distinguish different types of positive emotion systemsdistinguish different types of positive emotion systems
•• SelfSelf--toto--self relationships are important mediators between early self relationships are important mediators between early rearing styles and distressed states rearing styles and distressed states
•• CFT focuses on this inner relationship CFT focuses on this inner relationship –– shifting it to a self shifting it to a self compassionate onecompassionate one
•• First movements to compassion in selfFirst movements to compassion in self--critics are often aversive so critics are often aversive so this system needs to be ‘detoxified’ this system needs to be ‘detoxified’
•• Takes time and should focus on practice rather than focusing on Takes time and should focus on practice rather than focusing on feelings first upfeelings first up
•• Clients like the neurophysiological and Mind Training aspects Clients like the neurophysiological and Mind Training aspects ----like ‘going to the gym’ analogieslike ‘going to the gym’ analogies